scholarly journals MRI-based early diagnosis: a diabetic Charcot spine case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Barbara Limberger Nedel ◽  
Juliana Avila Duarte ◽  
Fernando Gerchman
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Soft Tissues ◽  
Fibrous Tissue ◽  
Lumbar Pain ◽  
Pathology Report ◽  
Mri Findings ◽  
Laboratory Test Results ◽  
Charcot Spine

Abstract Background Spinal neuroarthropathy (SNA), also known as Charcot spine, is an uncommon aggressive arthropathy, secondary to loss of proprioceptive and nociceptive feedback from the spine. A diagnosis of SNA is frequently delayed due to the scarcity of symptoms in its early stages, leading to significant neurological deterioration. Therefore, prompt suspicion of the disease is critical to providing better outcomes. This case assembles two rare characteristics of SNA: diabetic aetiology and a precocious time of diagnosis, and aims to highlight the magnetic resonance imaging (MRI) findings that allowed for the diagnosis. Case presentation A 44-year-old woman, with long-term type 1 diabetes, presented with a two-month history of progressive lumbar pain, difficulty in maintaining an upright position, and discrete trunk forward-leaning. Diabetes-related vasculopathy and nephropathy were already known, and laboratory test results did not show any new abnormalities. A lumbar MRI revealed extensive signal intensity changes of the L2 and L3 vertebral bodies associated with marginal areas of enhancement and the involvement of regions adjacent to interapophyseal articulations and spinous processes from L2–L3 to L5–S1, in association with degenerative changes of the thoracolumbar spine. These findings were identified by the radiologist as suggestive of SNA. To rule out neoplastic and infectious disease, a bone biopsy at the L2–L3 level was executed. The pathology report revealed intervertebral disc material and fragments of fibrous tissue, with a complete absence of inflammatory cells. It was decided to perform a six-month MRI follow-up, which showed stability of the findings, confirming the hypothesis of Charcot spine. The patient was under clinical and radiological follow-up and did not require surgical fixation at the moment of diagnosis. After 2.5 years from the initial diagnosis, a new MRI revealed progression of the lesions with oedema and enlarged paravertebral soft tissues; these findings are compatible with the patient’s latest complaints of lumbar pain recurrence. Conclusion To the best of our knowledge, this is the first case report of an MRI-based early diagnosis of diabetic SNA, a rare disease with nonspecific symptoms in its initial stages and a wide spectrum of differential diagnoses. The MRI findings, distinctly the involvement of both anterior and posterior spinal elements, were the key to allowing for the proper diagnosis. A precocious diagnosis, although challenging, is fundamental to providing early intervention and to preventing further neurological impairment.

scholarly journals Stand-Alone Rod Augmentation for Instrumentation Failure after Pedicle Subtraction Osteotomy: A Case Report with a 2-year Follow-up

2021 ◽  
Author(s):  
Mohammad Zarei ◽  
Mohsen Rostami ◽  
Furqan Mohammed Yaseen Khan
Keyword(s):  
Case Report ◽  
Spine Surgery ◽  
Callus Tissue ◽  
Scar Tissue ◽  
Pedicle Subtraction Osteotomy ◽  
Lumbar Pain ◽  
Sagittal Imbalance ◽  
Complex Procedure ◽  
Instrumentation Failure

Background: Revision surgery of spine can be a complex procedure and has known complications. It involves hardware revision, removal of scar/callus tissue, realignment of sagittal balance, and anterior augmentation. However, through this report, we aim to demonstrate that a stand-alone rod augmentation at the failure site without removal of scar/callus tissue and/or anterior fixation can achieve excellent results in select cases. Case Report: A 66-year-old woman underwent L2 pedicle subtraction osteotomy (PSO) + T9-iliac fixation for fixed sagittal imbalance and osteoporotic collapse of L3. One year later, she developed progressive axial lumbar pain and difficulty in mobilization. The patient was diagnosed with pseudoarthrosis and instrumentation failure and underwent revision spine surgery with stand-alone rod augmentation. She had anuneventful rehabilitation and showed complete radiographic union and excellent clinical outcome in the 2-year follow-up. Conclusion: Stand-alone rod augmentation can provide stable posterior construct to prevent future pseudoarthrosis and/or instrumentation failure after revision spine surgery in selected cases. Anterior augmentation or resection dural scar tissue or dissection through callus tissue is not always necessary.  

scholarly journals Self-Inflicted Gingival Injury Due to Habitual Fingernail Scratching: A Case Report with a 1-Year Follow Up

2009 ◽  
Vol 03 (02) ◽  
pp. 150-154 ◽  
Author(s):  
Alparslan Dilsiz ◽  
Tugba Aydin
Keyword(s):  
Case Report ◽  
Soft Tissues ◽  
Psychological Support ◽  
Physical Injury ◽  
Root Coverage ◽  
Periodontal Health ◽  
Gingival Bleeding ◽  
Traumatic Lesions ◽  
Oral Hygiene Instruction

ABSTRACTInjuries to oral soft-tissues can occur due to accidental, iatrogenic, and factitious traumas. Traumatic lesions, whether chemical, physical, or thermal in nature, are among the most common in the mouth. A type of physical injury to the gingival tissues is self-inflicted. Sometimes the lesions are termed gingivitis artefacta. Self-inflicted gingival injuries in children and adolescents can occur as a result of accidental trauma, premeditated infliction, or chronic habits such as fingernail biting, digit sucking, or sucking on objects such as pens, pencils or pacifiers. The purpose of this case report was to illustrate the destructive nature of the habit and to describe the successful treatment of this case. A 14-year-old girl with moderate pain, gingival bleeding and recession in the anterior mandibulary region was admitted to periodontology clinic. Upon questioning, the patient readily admitted traumatizing her gingiva with her fingernail. Treatment consisted of oral hygiene instruction, mechanical debridement, psychological support and surgical periodontal treatment. Postoperatively, complete root coverage, gains in clinical attachment levels, and highly significant increases in the width of keratinized gingiva were observed. This case report shows that it is possible to treat gingival injury and maintain the periodontal health of a patient with destructive habit. Patient compliance, regular dental follow-ups, and psychological support may be useful in stabilizing the periodontal condition of these patients. Dentists must be aware that self-inflicted gingival injury, although thought to be uncommon, is quite widespread. (Eur J Dent 2009;3:150-155)

Papillary Tumor of the Pineal Region with Parinaud Syndrome: A Case Report

2020 ◽  
Vol 16 (8) ◽  
pp. 1044-1047
Author(s):  
Lale Damgacı ◽  
Büşra Hayat ◽  
Servet Güreşçi
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Soft Tissue ◽  
World Health Organisation ◽  
Pineal Region ◽  
World Health ◽  
Pathology Report ◽  
Mri Findings ◽  
Papillary Tumor ◽  
Intravenous Contrast

Background: Less than 1% of all intracranial tumors are in the pineal region. Papillary tumor of the pineal region is considered one of four pineal parenchymal tumors according to the 2007 World Health Organisation classification of central nervous system tumors. It is mostly seen in the middle age and it is rare under the age of 17 in the literature. In this report, we aim to present a case with papillary tumor of the pineal region with both CT and MRI findings, and discuss the differential diagnosis. Case report: A 17-year-old female patient who underwent a treatment of ventriculoperitoneal shunt due to hydrocephalus 18 months ago applied to the neurosurgery clinic with nausea, vomiting, sensorineural hearing loss and Parinaud syndrome continuing through 1 month. Computed tomography (CT) and magnetic resonance imaging (MRI) have been applied. A 58x31x38 mm mass with cystic and mild hyperdense soft tissue components was observed in the localization of pineal gland and posterior comissure on non-enhanced CT. MRI examination revealed that the mass filled the pineal region, contained solid and large cystic components, and hyperintense on T1-weighted images. After intravenous contrast media injection, the mass enhanced more peripherally. DW-MRI showed that there is a diffusion restriction in some parts of the soft tissue components. The mass was totally resected, and pathology report revealed that it is a papillary tumor of the pineal region. Conclusion: When a T1-weighted hyperintense and CT hyperdense mass with cystic and solid components is seen in the pineal region, even if it is rare, papillary tumor should also be considered in the differential diagnosis after exclusion of other hyperintense lesions in T1-weighted imaging.

Atypical cells in sysmex UN automated urine particle analyzer: a case report and pitfalls for future studies

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Ozgur Aydin ◽  
Onur Yapıcı ◽  
Ruksan Copuroglu
Keyword(s):  
Case Report ◽  
Blood Cells ◽  
White Blood Cells ◽  
Pathology Report ◽  
Case Presentation ◽  
Future Studies ◽  
Atypical Cells ◽  
Papillary Lesions ◽  
Automated Instrument

AbstractObjectivesSysmex UN series fully automated urine analyzer reports a series of research parameters besides routine parameters including the “atypical cells” parameter. An automated instrument in clinical use capable of detecting neoplastic cells of the urinary tract will have paramount significance.Case presentationA 73 years old male patient with a recurrent high grade urothelial carcinoma admitted to our urology outpatient clinic due to hematuria.Urinalysis showed +3 hemoglobin, +3 leukocyte esterase, 200/HPF red blood cells, 300/HPF white blood cells. The instrument also reported atypical cells (7.6/µL or 1.3/HPF) under the heading of “research parameters.” Presence of atypical cells was confirmed by the manual microscopy. The patient has undergone transurethral resection of papillary lesions and the pathology report confirmed a recurrence. On follow-up, atypical cells fell to 0.1/µL after 40 days.ConclusionsThis case report presents a patient with atypical cells in urine, detected by a fully automated urine analyzer. The atypical cells presented on the screen of the analyzer were confirmed by the manual microscopy. This presentation may influence future studies pertaining to the subject.

scholarly journals Double orifice mitral valve: A case report

2016 ◽  
Vol 73 (5) ◽  
pp. 496-499
Author(s):  
Ljilja Music ◽  
Bozidarka Knezevic ◽  
Ljiljana Jovovic ◽  
Nebojsa Bulatovic
Keyword(s):  
Case Report ◽  
Mitral Valve ◽  
Mitral Stenosis ◽  
Fibrous Tissue ◽  
Bundle Branch Block ◽  
Functional Changes ◽  
Mitral Orifice ◽  
Sport Activities ◽  
Double Orifice

Introduction. Double orifice mitrol valve (DOMV) is a very rare congenital heart defect. Case report. We reported 20-year-old male referred to our center due to evaluation of his cardiologic status. He was operated on shortly after birth for a tracheoesophageal fistula. Accidentally, echocardiography examination at the age of 4 years revealed double orifice mitral valve (DOMV) without the presence of mitral regurgitation, as well as mitral stenosis, with normal dimensions of all cardiac chambers. The patient was asymptomatic, even more he was a kick boxer. His physical finding was normal. Electrocardiography showed regular sinus rhythm, incomplete right bundle branch block. Transthoracic echocardiography (TTE) examination revealed the normal size of the left atrial, mitral leaflets were slightly more redundant. The left and right heart chambers, aorta, tricuspid valve and pulmonary artery valve were normal. During TTE examination on a short axis view two asymmetric mitral orifices were seen as a double mitral orifice through which we registered normal flow, without regurgitation and mitral stenosis. Transesophageal echocardiography (TEE) examination from the transgastric view at the level of mitral valve, showed 2 single asymmetric mitral orifices separated by fibrous tissue, mitral leaflet with a separate insertion of hordes for each orifice. Conclusion. The presented patient with DOMV is the only one recognized in our country. The case is interesting because during 16-year a follow-up period there were no functional changes despite the fact that he performed very demanded sport activities. This is very important because there is no information in the literature about that.

scholarly journals Mandibular Ameloblastoma with Lung Metastasis 10 Years after Resection

2016 ◽  
Vol 31 (1) ◽  
pp. 53-56 ◽  
Author(s):  
Justin Iohanne Siy Rabo ◽  
Allan B. Carpela ◽  
Eutrapio S. Guevara ◽  
Joel A. Romualdez
Keyword(s):  
Case Report ◽  
Early Diagnosis ◽  
Lung Metastasis ◽  
Private Hospital ◽  
Primary Lesion ◽  
Standard Protocol ◽  
Adequate Treatment ◽  
High Propensity ◽  
Design Case

Objective:  To present a case of mandibular ameloblastoma with pulmonary metastasis after ten years and discuss the possible pathophysiology, diagnostic and therapeutic options. Methods: Study Design: Case Report Setting:           Tertiary Private Hospital Subject:          One Conclusion: Though benign, ameloblastoma has a high propensity for local invasion and may metastasize. It is difficult to predict metastasis, even with adequate treatment of the primary lesion. There is no standard protocol to prevent or detect metastatic ameloblastoma, but regular and close follow up may ensure early diagnosis. Keywords: ameloblastoma, metastatic ameloblastoma, lung metastasis, follicular type ameloblastoma, odontogenic tumor

scholarly journals Extra-Axial spinal Lumbar Neoplastic Lesions. A Rare Meningotelial entity: Fibroblastic Meningioma. Case Report and Revision of Litterature

2021 ◽  
Vol 8 (1) ◽  
pp. 01-04
Author(s):  
Gaspare Montemagno
Keyword(s):  
Case Report ◽  
Histological Examination ◽  
Neurological Deficits ◽  
Lumbar Pain ◽  
Spinal Tumors ◽  
Clinical Feature ◽  
Interlaminar Approach ◽  
Neoplastic Lesions ◽  
Fibroblastic Meningioma

Background and Importance In the field of spinal tumors, and in particular among extra-axial spinal and peripheral nerve tumors, the occurrence of dumbbell lumbar meningioma has not been reported in the literature. In the present study we describe a case of a patient suffering from dumbbell-shaped lumbar meningioma. This tumor resulted, after postoperative histological examination, a fibroblastic meningioma, WHO I grade, a very rare entity. Dumbbell meningiomas are extremely uncommon, comprising only 2–3.6 %. Clinical Presentation An 81-year-old man presented with history of gradually increasing lumbar pain, not related with decubitus and axial load, and right sciatica for 6 months. Another clinical feature was sensitive and motor (4/5 BMRCI) deficits at level of right L5 radicular territory. MRI shows a dumbell lesion in right neuroforamen L5-S1. With the patient in a prone position, we exposed and excised the tumor via a one stage posterolateral approach, through a hemi-laminictomy of L5, starting from a midline lumbar right L5-S1 interlaminar approach, extended to far lateral right articular and extra-articular region. We pre-operatively assumed the mass was a schwannoma because of its location and dumbbell shape, and planned the surgical procedure with use of continuous intraoperative neurophysiological neuromonitoring, to minimize the concrete risk of a possible intraoperative neurologic damage and preoperative neurological deficits worsening. Patient did not develop more deficits and the tumor resulted a fibroblastic meningioma. Patient recovered upright posture and walking during the first postoperative day, with the aid of a lumbar corset. The surgical wound was regular and subfascial lumbar drainage was removed on the first postoperative day. During postoperative recovery no additional neurological deficits appare and the low back pain and the right sciatic pain partially improved. On the fifth postoperative day patient was discharged from the hospital with the indications to wait for the histological examination result for any possible subsequent terapie and for the appropriate follow-up. Conclusion This patient-case report suggests that dumbbell shape of a spinal tumor (in particular at level of lumbar spine) has to be underwent to a very careful differential diagnosis, considering the possibility to discover, among the most frequent histology neoplastic lesions, the presence of histologically more rare tumors. This knowledge is very important from the beginning of surgical and therapeutic planning to the diagnostic and possible postoperative adiuvant therapeutic follow-up of patient.

scholarly journals The Correlation between Follow-up MRI Findings and Laboratory Results in Pyogenic Spondylodiscitis

2020 ◽  
Author(s):  
Kyung-Sik Ahn ◽  
Chang Ho Kang ◽  
Suk-Joo Hong ◽  
Baek Hyun Kim ◽  
Euddeum Shim
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Imaging Method ◽  
Mri Findings ◽  
Pyogenic Spondylodiscitis ◽  
Tissue Responses ◽  
Laboratory Results ◽  
Tissue Changes ◽  
Soft Tissue Changes

Abstract Background Although MRI is the gold-standard imaging method in the diagnosis of spondylodiscitis, role of follow-up imaging is debated and there can be discrepancies with regard to the significance of bony or soft tissue responses to treatment. Purpose of our study is to test whether the MRI changes on follow-up imaging correlate with laboratory findings of treatment response. Methods A total of 48 patients with pyogenic spondylodiscitis who underwent baseline and follow-up MRI were retrospectively reviewed. The extent of bone marrow edema, paravertebral soft tissue inflammation, and disc height were compared on baseline and follow-up MRIs with the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels obtained from the medical records at baseline and on follow-up. Relationships between the MRI and laboratory changes were analyzed using the Spearmann correlation test. Results The mean MRI follow-up period was 42.25 days. Based on the CRP (resolved: n=19, resolving: n=19, and aggravated: n=10), there was significant correlation between the laboratory results and the changes in the bone and soft tissues (p < 0.01, both). The correlation was best with soft tissue changes (rho: 0.48) followed by bony changes (rho: 0.41). Based on the ESR (resolved: n=8, resolving: n=22, and worsened: n=18), the correlation was stronger with bone changes (rho: 0.45, p < 0.01) than it was with soft tissue changes (rho: 0.39, p = 0.01). Conclusion Follow-up MRI findings of pyogenic spondylodiscitis show variable tissue responses. CRP was best correlated with soft tissue changes, while ESR showed the best association with bony changes.

scholarly journals Rare Osteochondroma of the Posterior Talar Process: A Case Report

2020 ◽  
Author(s):  
Luan Pham ◽  
Daniel Wu
Keyword(s):  
Case Report ◽  
Bone Tumors ◽  
Surgical Excision ◽  
Current Understanding ◽  
Pathology Report ◽  
Cartilage Formation ◽  
Benign Bone Tumors ◽  
Healthy Female

Osteochondromas are benign bone tumors that arise from divergent cartilage formation most commonly in childhood versus adulthood. We report the case of a 42-year-old healthy female who presented with a unusual solitary posterolateral ankle mass with associated pain and ankle impingement with 6 weeks follow up. The patient was successfully treated with open surgical excision with bone with pathology diagnosis of benign osteochondroma. The patient returned to normal baseline function with no pain at 6 weeks follow up. Open posterior ankle incision approach performed to remove suspicious enlarged bony growth from posterior talar process sent to pathology. Pathology report returned benign osteochondroma of the posterior talar process and patient subsequently had routine healing of post op incision site and return to full function without pain or disability at 6 weeks follow up. This case study adds to the current understanding, incidence, occurrence, and treatment of rare osteochondromas occurring in the posterior talar process.

Sign in / Sign up

Export Citation Format

Share Document