scholarly journals Clinical Reasoning: A 64-Year-Old Man With History of Meningitis Presenting With Proximal Weakness of the Arms

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000013085
Author(s):  
Philipp Karschnia ◽  
Leon Kaulen ◽  
Niklas Thon ◽  
Joachim M. Baehring
Keyword(s):  
Imaging Techniques ◽  
Final Diagnosis ◽  
Best Supportive Care ◽  
Conus Medullaris ◽  
Blood Analysis ◽  
Mri Findings ◽  
Csf Analysis ◽  
Lower Extremity Strength ◽  
History Of ◽  
Patient’S History

A 64-year-old man presented for evaluation of proximally pronounced weakness of the arms with preserved facial and lower extremity strength. Symptoms slowly developed over the last two years, and the patient’s history was notable for severe Listeria monocytogenes meningitis four years prior to presentation, which was adequately treated with antibiotics. On examination, symptoms clinically reassembled ‘man-in-the-barrel’ syndrome and localized to the cervicothoracic central cord. Blood analysis was unremarkable, and CSF analysis showed no recurrent or persistent infection. Spinal MRI revealed pockets of sequestered CSF from C3 to C4 and areas of CSF space effacement from C3 to T12. MRI findings were interpreted as cord tethering suggestive of adhesive arachnoiditis. CT myelogram showed insufficient contrast agent migration above T10 and contour irregularities of the conus medullaris, confirming the postulated pathomechanism of cord tethering. Final diagnosis was therefore cervicothoracic central cord damage due to cord tethering in the setting of postinfectious adhesive arachnoiditis following bacterial meningitis. The patient failed a course of pulsed methylprednisolone therapy, and symptoms progressed. Best supportive care was provided. The clinical presentation of adhesive arachnoiditis is variable, and advanced imaging techniques and invasive studies such as CT myelogram may be required to establish the diagnosis. Timely diagnosis is warranted as early surgical or medical therapy can improve symptoms.

BING-NEEL SYNDROME: A RARE CAUSE OF PROGRESSIVE GAIT DISTURBANCE AND DEMENTIA

2015 ◽  
Vol 86 (11) ◽  
pp. e4.73-e4
Author(s):  
Anisha Doshi ◽  
Anis Haque ◽  
Muhammad Chowdhury ◽  
Kevin Boyd
Keyword(s):  
Cauda Equina ◽  
Conus Medullaris ◽  
Gait Disturbance ◽  
Low Grade ◽  
Bone Marrow Trephine Biopsy ◽  
Csf Analysis ◽  
Elevated Protein ◽  
Extrapyramidal Signs ◽  
Limb Ataxia ◽  
History Of

A 69 year old retired lady presented with a 3 year history of progressive gait disturbance with unsteadiness and falls. Over the preceding year she had become recluse, failing to attend social gatherings and becoming anxious. She complained of lethargy and poor appetite and had lost weight. A witnessed generalised seizure led to admission. Examination revealed mixed pyramidal and extrapyramidal signs in the limbs with global hyperreflexia and upgoing plantars. There was upper limb ataxia with bilateral intention tremor and myoclonus. She was only obeying one stage commands.Investigations revealed elevated ESR and monoclonal IgM kappa band with paraprotein concentration 9.4 g/L. MRI whole axis revealed periventricular diffuse T2 and FLAIR signal change and prominence of the leptomeninges along the distal spinal cord, conus medullaris and cauda equina. Bone scan showed prominent uptake within both humeri. Bone marrow trephine biopsy indicated a low-grade B-cell lymphoproliferative disorder; lymphoplasmacytic lymphoma. Serial CSF analysis revealed lymphocytic pleocytosis with elevated protein of 4.47–6.25 g/L. CSF protein electrophoresis demonstrated the presence of an IgM paraprotein with monoclonal IgM kappa band on immunonofixation. CSF immunophenotyping confirmed the presence of clonal B–cells.We therefore present a rare case of Bing-Neel Syndrome, CNS manifestation of Wäldenstroms Macroglobulinaemia.

The frequency and characteristics of MS misdiagnosis in patients referred to the multiple sclerosis centre of Catalonia

2021 ◽  
pp. 135245852098814 ◽  
Author(s):  
Luciana Midaglia ◽  
Jaume Sastre-Garriga ◽  
Agustín Pappolla ◽  
Laura Quibus ◽  
René Carvajal ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Low Frequency ◽  
White Matter Lesions ◽  
Final Diagnosis ◽  
Personal History ◽  
Contributing Factors ◽  
Mri Findings ◽  
History Of ◽  
A Prospective Study

Background: Multiple sclerosis (MS) misdiagnosis may cause physical and emotional damage to patients. Objectives: The objective of this study is to determine the frequency and characteristics of MS misdiagnosis in patients referred to the Multiple Sclerosis Centre of Catalonia. Methods: We designed a prospective study including all new consecutive patients referred to our centre between July 2017 and June 2018. Instances of misdiagnosis were identified, and referral diagnosis and final diagnosis were compared after 1 year of follow-up. Association of misdiagnosis with magnetic resonance imaging (MRI) findings, presence of comorbidities and family history of autoimmunity were assessed. Results: A total of 354 patients were referred to our centre within the study period, 112 (31.8%) with ‘established MS’. Misdiagnosis was identified in eight out of 112 cases (7.1%). MRI identified multifocal white matter lesions, deemed non-specific or not suggestive of MS in all misdiagnosed cases. Patients with MS misdiagnosis had more comorbidities in general than patients with MS ( p = 0.026) as well as a personal history of autoimmunity ( p < 0.001). Conclusion: A low frequency of MS misdiagnosis was found in our clinical setting. Multifocal non-specific white matter lesions in referral MRI examinations and the presence of comorbidities, including a personal history of autoimmunity, seem to be contributing factors to misdiagnosis.

scholarly journals Eczema-like plaques secondary to enoxaparin misdiagnosed as DRESS-syndrome

2021 ◽  
Vol 12 (e) ◽  
pp. e60-e60
Author(s):  
Kamar Belhareth ◽  
Rim Sahnoun ◽  
Sonia Boudaya ◽  
Kamilia Ksouda ◽  
Emna Bahloul ◽  
...  
Keyword(s):  
Hemorrhagic Stroke ◽  
Final Diagnosis ◽  
Sudden Onset ◽  
Blood Analysis ◽  
Dress Syndrome ◽  
Low Molecular Weight Heparins ◽  
Skin Reactions ◽  
History Of ◽  
Facial Edema ◽  
Clinical Pictures

Low-molecular-weight heparins may cause adverse skin reactions, especially eczematous eruptions. A 60-year-old woman with a history of mitral valve replacement and frontal hemorrhagic stroke, who had been treated with carbamazepine and enoxaparin for 2 months, consulted our department for a sudden onset of generalized pruritic rash. There was facial edema, cheilitis, and a rash of eczematous lesions electively localized to the site of enoxaparin injections. Blood analysis showed eosinophilia= 2500 e/mm3, gamma GT = 526 and lipasemia= 126. Initially we suspected the diagnosis of carbamazepine induced DRESS syndrome. Then the final diagnosis was generalized eczema on heparin in view of the exclusive localization of the lesions at the sites of enoxaparin injections, the rapid resolution of the eruption and the result of biopsy and allergological investigation. Dermatologic effects of heparins commonly used in medical and surgical practice are numerous, and clinical pictures can be misleading, as in our case.

scholarly journals PRES, a diagnostic dilemma in pregnancy: three case series with unusual presentation

2018 ◽  
Vol 7 (10) ◽  
pp. 4313
Author(s):  
Sudhir Mansingh ◽  
Gunjan Rai ◽  
Bikram Bhardwaj
Keyword(s):  
Case Series ◽  
Fetal Distress ◽  
Final Diagnosis ◽  
Unusual Presentation ◽  
Mri Findings ◽  
Diagnostic Dilemma ◽  
Co Morbidity ◽  
History Of ◽  
Period Of Gestation ◽  
In Pregnancy

Authors report a series of three cases of unusual presentation of posterior reversible encephalopathy syndrome in pregnancy. First patient, 29 years old G2P1L1, who was a booked case at our hospital, presented with complain of no fetal movement perception for 3 days at 27 weeks of period of gestation. No history of hypertension and even no record of hypertension after admission. On USG detected to have severe early onset IUGR and AEDF in Umbilical artery doppler. Went in to spontaneous labor and delivered vaginally a preterm neonate of birth weight of 740 gms at 27 weeks 06 days of period of gestation. Postpartum period was uneventful till day four and on day five of postpartum she developed severe headache and seizure. MRI done which was suggestive of PRES. Second patient 27 years old primi gravida with 37 weeks 01 day, booked at our hospital with regular ANC visit brought with history of headache, vomiting with semi-conscious state with diminution of vision till finger count only. She developed seizure thrice while examination. Antenatal period was uneventful with no history of hypertension. Underwent emergency LSCS on same day and delivered a 2.8 kg healthy female neonate. Patient treated as a case of eclampsia and later MRI findings were suggestive of PRES. Third patient 19 years old primigravida booked ANC case at another hospital. She underwent emergency LSCS at 39 weeks POG for fetal distress at same hospital. Antenataly no history of hypertension or any other co-morbidity. On fourth post-op day, she developed headache and vomiting followed by one episode of seizure and after initial management she transferred to our hospital for further management. When we received patient, she was on Magsulph infusion considering postnatal eclampsia. We managed with Inj Lorazepam 2 mg intravenous and later with Inj Levetiracitam. Final diagnosis has been made as PRES after MRI and MRV brain. We found very atypical presentation of all three cases with difficulty in diagnosis and challenging management, so we are reporting these cases.

Preoperative localization of parathyroid glands

2004 ◽  
Vol 43 (03) ◽  
pp. 85-90 ◽  
Author(s):  
E. Lopez Hänninen ◽  
Th. Steinmüller ◽  
T. Rohlfing ◽  
H. Bertram ◽  
M. Gutberlet ◽  
...  
Keyword(s):  
Image Fusion ◽  
Single Photon ◽  
Imaging Techniques ◽  
Photon Emission ◽  
Parathyroid Glands ◽  
Preoperative Localization ◽  
Mri Findings ◽  
99Mtc Mibi ◽  
Weighted Sequences ◽  
Mibi Scintigraphy

Summary Aim: Minimally invasive resection of hyperfunctional parathyroid glands is an alternative to open surgery. However, it requires a precise preoperative localization. This study evaluated the diagnostic use of magnetic resonance (MR) imaging, parathyroid scintigraphy, and consecutive image fusion. Patients, methods: 17 patients (9 women, 8 men; age: 29-72 years; mean: 51.2 years) with primary hyperparathyroidism were included. Examination by MRI used unenhanced T1- and T2-weighted sequences as well as contrast-enhanced T1-weighted sequences. 99mTc-MIBI scintigraphy consisted of planar and SPECT (single photon emission tomography) imaging techniques. In order to improve the anatomical localization of a scintigraphic focus, SPECT-data were fused with the corresponding MR-data using a modified version of the Express 5.0 software (Advanced Visual Systems, Waltham, MA). Results of image fusion were then compared to histopathology. Results: In 14/17 patients, a single parathyroid adenoma was found. There were 3 cases with hyperplastic glands. MRI detected 10 (71%), scintigraphy 12 (86%) adenomas. Both modalities detected 1/3 patients with hyperplasia. Image fusion improved the anatomical assignment of the 13 scintigraphic foci in five patients and was helpful in the interpretation of inconclusive MR-findings in two patients. Conclusions: Both MRI and 99mTc-MIBI scintigraphy sensitively detect parathyroid adenomas but are less reliable in case of hyperplastic glands. In case of a scintigraphic focus, image fusion considerably improves its topographic assignment. Furthermore, it facilitates the evaluation of inconclusive MRI findings.

Computed Tomography and Magnetic Resonance Imaging-aided Diagnosis of Primary Essential Cutis Verticis Gyrata: A Case Report with 5-year Follow-up and Review of the Literature

2019 ◽  
Vol 15 (9) ◽  
pp. 906-910
Author(s):  
Hongzhang Zhu ◽  
Shi-Ting Feng ◽  
Xingqi Zhang ◽  
Zunfu Ke ◽  
Ruixi Zeng ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Three Dimensional ◽  
Stable Condition ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Cutis Verticis Gyrata ◽  
Essential Form ◽  
History Of ◽  
Magnetic Resonance Imaging Mri

Background: Cutis Verticis Gyrata (CVG) is a rare skin disease caused by overgrowth of the scalp, presenting as cerebriform folds and wrinkles. CVG can be classified into two forms: primary (essential and non-essential) and secondary. The primary non-essential form is often associated with neurological and ophthalmological abnormalities, while the primary essential form occurs without associated comorbidities. Discussion: We report on a rare case of primary essential CVG with a 4-year history of normal-colored scalp skin mass in the parietal-occipital region without symptom in a 34-year-old male patient, retrospectively summarizing his pathological and Computer Tomography (CT) and magnetic resonance imaging (MRI) findings. The major clinical observations on the CT and MR sectional images include a thickened dermis and excessive growth of the scalp, forming the characteristic scalp folds. With the help of CT and MRI Three-dimensional (3D) reconstruction techniques, the characteristic skin changes could be displayed intuitively, providing more evidence for a diagnosis of CVG. At the 5-year followup, there were no obvious changes in the lesion. Conclusion: Based on our observations, we propose that not all patients with primary essential CVG need surgical intervention, and continuous clinical observation should be an appropriate therapy for those in stable condition.

scholarly journals Development of a Field Deployable Firebrand Flux and Condition Measurement System

2020 ◽  
Author(s):  
Simone Zen ◽  
Jan C. Thomas ◽  
Eric V. Mueller ◽  
Bhisham Dhurandher ◽  
Michael Gallagher ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Time History ◽  
Infrared Camera ◽  
Thermal Conditions ◽  
Particle Characterization ◽  
Fire Dynamics ◽  
Rate Of Spread ◽  
New Instrument ◽  
History Of

AbstractA new instrument to quantify firebrand dynamics during fires with particular focus on those associated with the Wildland-Urban Interface (WUI) has been developed. During WUI fires, firebrands can ignite spot fires, which can rapidly increase the rate of spread (ROS) of the fire, provide a mechanism by which the fire can pass over firebreaks and are the leading cause of structure ignitions. Despite this key role in driving wildfire dynamics and hazards, difficulties in collecting firebrands in the field and preserving their physical condition (e.g. dimensions and temperature) have limited the development of knowledge of firebrand dynamics. In this work we present a new, field-deployable diagnostic tool, an emberometer, designed to provide measurement of firebrand fluxes and information on both the geometry and the thermal conditions of firebrands immediately before deposition by combining a visual and infrared camera. A series of laboratory experiments were conducted to calibrate and validate the developed imaging techniques. The emberometer was then deployed in the field to explore firebrand fluxes and particle conditions for a range of fire intensities in natural pine forest environments. In addition to firebrand particle characterization, field observations with the emberometer enabled detailed time history of deposition (i.e. firebrand flux) relative to concurrent in situ fire behaviour observations. We highlight that deposition was characterised by intense, short duration “showers” that can be reasonably associated to spikes in the average fire line intensity. The results presented illustrate the potential use of an emberometer in studying firebrand and spot fire dynamics.

scholarly journals Mesenteric Cysts: A Retrospective Review. Its Not All That Simple

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S117-S118
Author(s):  
M Bourgeau ◽  
V Avadhani
Keyword(s):  
Cyst Wall ◽  
Imaging Techniques ◽  
Case Reports ◽  
Lymphatic Vessels ◽  
Mucinous Cystadenoma ◽  
Final Diagnosis ◽  
Cystic Mass ◽  
Pathological Examination ◽  
Urachal Cyst ◽  
Mesenteric Cysts

Abstract Introduction/Objective Mesenteric cysts are rare intra-abdominal lesions in adults. However, with the advanced imaging techniques and laparoscopic techniques, they are more often being identified and resected when clinically significant. There is a lack of detailed information in histopathology (except as case reports) since mesentery is generally neglected in our organ-based textbooks. The aim of our study is to highlight the importance of identifying and classifying mesenteric cystic lesions; they are not all that simple. Methods We performed a retrospective search on all mesenteric cysts submitted as excisions in our electronic database from 2013-2019. We classified them as per the de Perrot (PMID: 11053936) classification with modification. Results Our search showed: A. Lymphatic origin-11 (lymphangioma-10, Lymphangioma hamartomatous-1, associated with LAM-0), B. Mesothelial origin-68 (Benign mesothelial cysts-57, multilocular mesothelial cyst-11), C. Enteric origin- 3, D. Urogenital origin (Urachal cyst, mullerian inclusion cyst)-9, E. Mature cystic teratom-2, F. Pseudocyst-12, G. Epithelial cyst (not urogenital)- 11 (a/w LAMN-3, MCN-4, Mucinous cystadenoma-4), H. Associated with carcinoma-2. Case illustration: A 61-year-old male presented with worsening dysphagia, emesis and hiccups. A CT scan showed a 21.2 cm cystic mass with at least one septation (Fig 1). The cyst was resected. On gross pathological examination, the cyst measured 18 cm in greatest dimension with a thick, rough, tan-brown capsule. Microscopic examination showed a fibrous capsule, and cyst wall composed of numerous lymphatic vessels (CD31 positive) and prominent smooth muscle proliferation (Desmin positive). Scattered lymphoid aggregates were also present throughout the cyst wall. No definite epithelial lining was identified and was suspected to have been denuded. HMB-45 immunostain was negative, ruling out association with LAM. The final diagnosis of a Lymphangiomyoma, hamartomatous was rendered. Conclusion Though most of the mesenteric cysts are benign, some of them are significantly important such as Lymphangiomyoma (esp secondary to LAM), MCN, those associated with LAMN etc. and identifying and differentiating from their mimics has distinct clinical implications.

scholarly journals Endometriosis Mimicking a Cecum Mass with Complete Bowel Obstruction: An Infrequent Cause of Acute Abdomen

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Gabriel A. Molina ◽  
Darwin R. Ramos ◽  
Alberto Yu ◽  
Patricio A. Paute ◽  
Paul S. Llerena ◽  
...  
Keyword(s):  
Intestinal Obstruction ◽  
Bowel Obstruction ◽  
Preoperative Diagnosis ◽  
Malignant Tumors ◽  
Signs And Symptoms ◽  
Final Diagnosis ◽  
Intestinal Involvement ◽  
History Of ◽  
Ovarian Abscess ◽  
Fertile Women

Endometriosis is a common entity among fertile women which unfortunately manifests through variable symptomatology. Intestinal involvement in endometriosis is quite common and can simulate several diseases such as Crohn’s disease, appendicitis, tubo-ovarian abscess, or malignant tumors. Intestinal obstruction due to endometriosis is rare, and preoperative diagnosis is difficult because the signs and symptoms are nonspecific and can be easily confused. In the case of patients without a history of endometriosis, diagnosis is further complicated. We present a case of a 41-year-old female patient. She presented to the emergency room with complete bowel obstruction and a mass in the cecum. Surgery was decided, and the patient underwent full recovery. Endometriosis was the final diagnosis for the observed condition.

scholarly journals Tuberculosis presenting as dacryoadenitis in the USA

2019 ◽  
Vol 12 (11) ◽  
pp. e231694 ◽  
Author(s):  
Harry Ross Powers ◽  
Mark Anthony Diaz ◽  
Julio C Mendez
Keyword(s):  
Correct Diagnosis ◽  
Developed Countries ◽  
Histopathological Analysis ◽  
Orbital Mass ◽  
Antituberculosis Therapy ◽  
The Usa ◽  
History Of ◽  
Patient’S History ◽  
High Degree ◽  
Filipino Woman

A 25-year-old Filipino woman living in the USA was evaluated for a 5-month history of left eye pain and a subsequent orbital mass. Histopathological analysis of the lacrimal mass showed a mixed inflammatory process with necrotising granulomas and positive cultures for Mycobacterium tuberculosis. She was treated with antituberculosis therapy, with resolution of symptoms. Tuberculosis dacryoadenitis is extremely rare in the USA and other developed countries. It requires a high degree of clinical suspicion with special attention to the patient’s history to make the correct diagnosis. It can be treated successfully with antituberculosis therapy.

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