Treatment of Harlequin Syndrome by Costotransversectomy and Sympathectomy: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. E257-E259 ◽  
Author(s):  
Eric Anthony Sribnick ◽  
Nicholas M Boulis
Keyword(s):  
Clinical Presentation ◽  
Radicular Pain ◽  
Sudden Onset ◽  
Curative Therapy ◽  
Harlequin Syndrome ◽  
Random Intervals ◽  
Surgical History ◽  
History Of ◽  
Case Presentations ◽  
The Brain

Abstract BACKGROUND AND IMPORTANCE: Harlequin syndrome is a rare neurological condition involving various degrees of unilateral hyperhidrosis and erythema of the head and neck. We present a clinical presentation and description of curative therapy in a patient with a sudden onset of Harlequin syndrome following a thoracotomy. CLINICAL PRESENTATION: A 42-year-old female with a history of mastectomy for right-sided breast cancer subsequently had a left partial pneumonectomy for a metastasis. Postoperatively, she had onset of contralateral neck and facial flushing and sweating. Flushing was triggered by emotion and exercise, but also occurred spontaneously at random intervals. Magnetic resonance imaging of the brain, cervical spine, and thoracic spine were negative for pathology. Because of the patient's surgical history and negative workup, she was given a diagnosis of Harlequin syndrome. Surgical intervention consisted of a partial right T3 costotransversectomy with T2 sympathectomy. Postoperatively, the patient's symptoms of Harlequin syndrome resolved. The procedure was complicated by T1 radicular pain, which responded well to Gabapentin. CONCLUSION: The diagnosis of Harlequin syndrome is relatively new, and the majority of the scientific literature is concerned with descriptive case presentations. We present a surgical technique for the treatment of Harlequin syndrome.

scholarly journals Atypical Euglycemic Ketoacidosis in a non-diabetic Patient due to acute pancreatitis

2021 ◽  
Vol 11 (3) ◽  
pp. 332-336
Author(s):  
Andree Emanuilov Manov ◽  
Ikechukwu Ogbu
Keyword(s):  
Acute Pancreatitis ◽  
Metabolic Acidosis ◽  
Medical History ◽  
Clinical Presentation ◽  
Sudden Onset ◽  
Low Grade ◽  
Past Medical History ◽  
Pleuritic Chest Pain ◽  
Severe Metabolic Acidosis ◽  
History Of

We describe the case of a previously healthy 40- year-old Female with a known medical history of essential hypertension (HTN). She did not have past medical history of Diabetes Mellitus. She presents to the emergency department with sudden onset of severe shortness of breath that began shortly after non-bilious, non-bloating emesis. She also reported low-grade fever, nausea, cough, abdominal pain, pleuritic chest pain, and generalized weakness. She was found to have acute pancreatitis. She was diaphoretic. She had Kussmaul breathing. She was subsequently admitted to the intensive care unit (ICU) for severe metabolic acidosis. The cause of her metabolic acidosis and clinical presentation was found to be the acute pancreatitis which very rarely can be the cause of euglycemic ketoacidosis.

Supratentorial Arachnoid Cyst Located in the Brain Parenchyma: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. E258-E262 ◽  
Author(s):  
Kyung-Jae. Park ◽  
Shin-Hyuk. Kang ◽  
Yang-Seok. Chae ◽  
Yong-Gu. Chung
Keyword(s):  
Frontal Lobe ◽  
Arachnoid Cyst ◽  
Clinical Presentation ◽  
Brain Parenchyma ◽  
Cystic Mass ◽  
Clear Fluid ◽  
Computed Tomographic ◽  
History Of ◽  
The Right ◽  
The Brain

abstract BACKGROUND AND IMPORTANCE: Arachnoid cysts have not been reported to be located within the brain parenchyma. We present a case of an arachnoid cyst that was contained entirely within the right frontal lobe devoid of communication with the subarachnoid space and ventricle. CLINICAL PRESENTATION: A 65-year-old woman presented with a 1-year history of progressive headache and nausea. Computed tomographic and magnetic resonance imagining scans showed a well-defined, nonenhancing mass measuring 5 × 5 × 3.5 cm in the right frontal lobe. The mass appeared to be contained entirely within the brain parenchyma. The patient underwent a right frontal craniotomy, at which time the cystic mass was identified in the brain parenchyma without any communication with the arachnoid space. The cyst contained a clear fluid, and its wall was excised. The fluid contents demonstrated a composition similar to that of normal cerebrospinal fluid. Histological and immunohistochemical examinations of the cyst wall were compatible with the diagnosis of an arachnoid cyst. Postoperatively, the symptoms of the patient resolved, and no recurrence was observed up to 6 months after removal. CONCLUSION: The present case showed an intraparenchymal arachnoid cyst arising in the frontal lobe. Although the etiology is not known, an arachnoid cyst should be included in the differential diagnosis of primary intracerebral cysts.

scholarly journals Gas in gallbladder—gallstone ileus?

2019 ◽  
Vol 2019 (8) ◽  
Author(s):  
Siang Wei Gan ◽  
Reizal Mohd Rosli ◽  
George Kiroff ◽  
Abdullah Muhammad Rana ◽  
Darren Tonkin
Keyword(s):  
Clinical Presentation ◽  
Gallstone Ileus ◽  
Gallstone Disease ◽  
Surgical Patients ◽  
Soft Tissue Density ◽  
Abdominal Radiography ◽  
Uncommon Presentation ◽  
Plain Abdominal Radiography ◽  
Surgical History ◽  
History Of

Abstract Gallstone ileus is an uncommon presentation among acute surgical patients. Its diagnosis is often delayed due to its non-specific clinical presentation. We report the case of an 81-year-old gentleman with a 2-day history of small bowel obstruction (SBO). He had a history of gallstone disease and no past surgical history. Plain abdominal radiography was consistent with SBO. A computed tomography (CT) abdomen scan would be warranted given the presentation of SBO in a virgin abdomen. However, this case emphasizes the importance of early CT imaging in a case of suspected gallstone ileus given that the diagnosis could not be made on plain abdominal radiography. CT abdomen is superior in detecting small amounts of gas and at discriminating soft tissue density.

scholarly journals Lateral Medullary Syndrome (Wallenberg's Syndrome) - A Case Report

1970 ◽  
Vol 5 (1) ◽  
pp. 35-36 ◽  
Author(s):  
R Saha ◽  
S Alam ◽  
MA Hossain
Keyword(s):  
Case Report ◽  
Ischaemic Stroke ◽  
Posterior Inferior Cerebellar Artery ◽  
Sudden Onset ◽  
Appropriate Treatment ◽  
Cerebellar Artery ◽  
Lateral Medullary Syndrome ◽  
Great Vessels ◽  
History Of ◽  
The Brain

The Lateral medullary syndrome is not a very common stroke. Sometimes it is under diagnosed. Mr. Ibrahim Mollah, 50 years old male person, non diabetic, non hypertensive but smoker presented with the history of sudden onset of dysphagia, dysarthria and ataxia of the gait. He is clinically and radiologically diagnosed as a case of Lateral medullary syndrome (Ischaemic stroke). With treatment this patient improved significantly. It is commonly caused by occlusion of the cranial segment of the vertebral artery or the posterior inferior cerebellar artery. The occlusion may be due to thrombosis or embolism. The emboli are coming from the heart or the great vessels. We can diagnose Lateral medullary syndrome with expert clinical eye and CT/MRI of the brain. It should be managed with appropriate treatment and physiotherapy. DOI: 10.3329/fmcj.v5i1.6813Faridpur Med. Coll. J. 2010;5(1):35-36

scholarly journals Sudden Onset, Rapidly Expansile, Cervical Cystic Hygroma in an Adult: A Rare Case with Unusual Presentation and Extensive Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Vivek Dokania ◽  
Anagha Rajguru ◽  
Harmanjot Kaur ◽  
Ketan Agarwal ◽  
Sujata Kanetkar ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Cystic Hygroma ◽  
Sudden Onset ◽  
Histopathological Analysis ◽  
Extensive Literature ◽  
Mri Findings ◽  
Posterior Triangle ◽  
Complete Surgical Resection ◽  
History Of ◽  
Prior Trauma

Cystic hygroma (CH) is a benign infiltrative malformation of the lymphatic channels. We report a case of a 28-year-old Indian female who presented with rapidly enlarging right sided neck swelling over the posterior triangle since 5 days. Complete resection of CH is sometimes not amenable because of its infiltrative nature and involvement of surrounding vital structures. However, in our patient successful complete surgical resection was undertaken. The MRI findings of our patient were consistent with brachial cleft cyst; this posed a challenge in the diagnosis of CH. The histopathological analysis of the resected mass confirmed CH. CH is rare in adults and such an acute presentation is exceptionally atypical. History of prior trauma and infection are known etiological factors for adult CH; these were conspicuously absent in our patient. CH should be considered in the differentials of rapidly enlarging cystic swelling of posterior region of neck in adults. Optimal and timely management is necessary to achieve a favorable prognosis. Therefore, we report a case of rapidly enlarging cervical CH in an adult along with extensive literature review to have a better understanding regarding epidemiology, etiopathogenesis, clinical presentation, optimal management, and prognosis of such a rare entity in adults.

scholarly journals Histopathology of brain AVMs part I: microhemorrhages and changes in the nidal vessels

2020 ◽  
Vol 162 (7) ◽  
pp. 1735-1740
Author(s):  
Patrik Järvelin ◽  
Roosa Wright ◽  
Henri Pekonen ◽  
Sara Keränen ◽  
Tuomas Rauramaa ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Clinical Course ◽  
Neutrophil Infiltration ◽  
Histopathological Changes ◽  
Tissue Samples ◽  
Perivascular Inflammation ◽  
History Of ◽  
Brain Avms ◽  
The Brain

Abstract Background Arteriovenous malformations of the brain (bAVM) may rupture from aneurysms or ectasias of the feeding, draining, or nidal vessels. Moreover, they may rupture from the immature, fragile nidal vessels that are characteristic to bAVMs. How the histopathological changes of the nidal vessels associate with clinical presentation and hemorrhage of the lesion is not well known. Materials and methods We investigated tissue samples from surgically treated bAVMs (n = 85) using standard histological and immunohistochemical stainings. Histological features were compared with the clinical presentation of the patient. Results Microhemorrhages from nidal vessels were found both in bAVMs with a history of clinically evident rupture and in bAVMs considered unruptured. These microhemorrhages were associated with presence of immature, pathological nidal vessels (p = 0.010) and perivascular inflammation of these vessels (p = 0.001), especially with adhesion of neutrophils (p < 0.001). In multivariate analysis, perivascular inflammation (OR = 19, 95% CI 1.6 to 230), neutrophil infiltration of the vessel wall (OR = 13, 95% CI 1.9 to 94), and rupture status (OR = 0.13, 95% CI 0.017 to 0.92) were significantly associated with microhemorrhages. Conclusions Clinically silent microhemorrhages from nidal vessels seem to be very common in bAVMs, and associate with perivascular inflammation and neutrophil infiltration. Further studies on the role of perivascular inflammation in the clinical course of bAVMs are indicated.

Anterior Endoscopic Treatment of a Huge Anterior Sacral Meningocele: Technical Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (5) ◽  
pp. 1231-1234
Author(s):  
Byung-Chan Jeon ◽  
Do-Heon Kim ◽  
Ki-Young Kwon
Keyword(s):  
Subarachnoid Space ◽  
Endoscopic Treatment ◽  
Clinical Presentation ◽  
Spinal Dysraphism ◽  
Radicular Pain ◽  
Abdominal Incision ◽  
Meningeal Irritation ◽  
Spinal Subarachnoid Space ◽  
Anterior Sacral Meningocele ◽  
History Of

Abstract OBJECTIVE AND IMPORTANCE Anterior endoscopic treatment of a huge anterior sacral meningocele, a rare example of spinal dysraphism, is described. CLINICAL PRESENTATION A 43-year-old woman presented with severe headache and fever, increasing abdominal pain, and a several-year history of right lower-extremity radicular pain. She exhibited meningeal irritation signs and Currarino's triad. Lumbosacral myelograms and magnetic resonance imaging scans revealed a huge anterior sacral cyst connected with the spinal subarachnoid space. INTERVENTION A straight rigid endoscope was introduced into the meningocele through a small abdominal incision. The fistula between the meningocele and the spinal subarachnoid space was obliterated with multiple fat grafts harvested from the abdomen. CONCLUSION An anterior endoscopic procedure is an alternative for the treatment of a huge anterior sacral meningocele.

scholarly journals A Pediatric Case of Reversible Segmental Cerebral Vasoconstriction

2006 ◽  
Vol 33 (2) ◽  
pp. 250-253 ◽  
Author(s):  
Adam Kirton ◽  
John Diggle ◽  
William Hu ◽  
Elaine Wirrell
Keyword(s):  
Previous History ◽  
Sudden Onset ◽  
Thunderclap Headache ◽  
Deep Dive ◽  
Cerebral Vasoconstriction ◽  
History Of ◽  
Repeat Angiography ◽  
The Right ◽  
Work Up ◽  
The Brain

ABSTRACT:Background:Reversible segmental cerebral vasoconstriction (RSCV) is a recognizable clinical and radiographic syndrome consisting of thunderclap headache with or without focal neurological symptoms combined with reversible segmental vasoconstriction of proximal cerebral blood vessels.Methods:We report a case of reversible segmental cerebral vasoconstriction in a child.Results:A healthy 13-year-old boy experienced the sudden onset of a severe, diffuse headache upon surfacing from a deep dive in a swimming pool. Severity was maximal at the onset and improved over several hours. The same headache recurred three times over the next four days and a low baseline headache persisted throughout. Vomiting occurred once and mild photo/osmophobia were reported but throbbing, aura, or autonomic symptoms were absent. Focal neurological signs or symptoms were absent and he denied previous history of headaches, medications, drugs, or trauma. Two normal CT scans were performed within hours of separate headaches. Cerebrospinal fluid study on day 5 was bloody with no xanthochromia. MRI/MRA/MRV of the brain and vasculitic work-up were normal. Cerebral angiography on day 6 demonstrated smooth narrowing of multiple proximal cerebral vessels including supraclinoid internal carotid artery (ICA), M1, and A1 on the right and M1 on the left. By ten days, the patient's headaches had resolved and repeat angiography was normal.Conclusion:RSCV should be considered in a child with thunderclap headache.

scholarly journals Gangrenous jejunogastric intussuception as a complication of gastric surgery

2012 ◽  
Vol 43 (1-2) ◽  
pp. 18-20
Author(s):  
SM Hossain ◽  
AKMR Iqbal ◽  
SF Ahmed ◽  
MW Rahman
Keyword(s):  
Case Report ◽  
Clinical Presentation ◽  
Epigastric Pain ◽  
Previous History ◽  
Gastric Surgery ◽  
Sudden Onset ◽  
Palpable Mass ◽  
Post Operative Period ◽  
Jejunogastric Intussusception ◽  
History Of

Jejunogastric intussusception (JGI) is a rare but serious complication following gastrojenjunostomy operation. Clinical presentation may be acute or chronic. The efferent loop intussusception is most frequent type. Our case report include a 60 years male presented with sudden onset of epigastric pain, vomiting, hematemesis and a palpable mass at epigastrium with previous history of gastric surgery about 11 years back. Diagnosis of JGI was confirmed with endoscopy findings. After prompt resuscitation early surgery was done. Gangrenous segment was resected and revision surgery was done in Roux-en-Y pattern. Post-operative period was uneventful. Awareness of such complication, early diagnosis and prompt surgery can reduce the mortality of JGI. DOI: http://dx.doi.org/10.3329/bmjk.v43i1-2.13018 Bang Med J (Khulna) 2010; 43: 18-20

Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

2020 ◽  
Vol 5 (1) ◽  
pp. 88-96
Author(s):  
Mary R. T. Kennedy
Keyword(s):  
College Students ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sense Of Self ◽  
Scientific Evidence ◽  
Sudden Onset ◽  
Lessons Learned ◽  
Speech Language Pathologists ◽  
The Brain ◽  
Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

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