Bilateral Subdural Haematoma and CPAP Use: A Possible Association

Obstructive sleep apnoea (OSA) is a common condition usually treated with continuous positive airway pressure (CPAP). No reports have linked it to an acute subdural haematoma. A 54-year-old white man who had hypertension well controlled with an angiotensin II receptor blocker, presented with a 2-week history of occipital headache with no other focal neurological symptoms. The headache began 12 days after he had started using CPAP for OSA. A brain MRI performed 2 weeks later showed bilateral subdural haematomas which were chronic on the left and sub-acute/acute on the right. Since the patient was clinically stable with no focal neurological deficits, he received prednisone for 3 weeks and was followed up with consecutive CT scans demonstrating gradual regression of the haematomas. This is the first report showing that subdural haematomas could be linked to CPAP use.

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Beware of the Anticoagulated Elderly with Minor Head Injury

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490790501200202 ◽

2005 ◽

Vol 12 (2) ◽

pp. 108-111

Author(s):

CH Chung

Keyword(s):

Head Injury ◽

Subdural Haematoma ◽

The Elderly ◽

Minor Head Injury ◽

Loss Of Consciousness ◽

X Rays ◽

Acute Subdural Haematoma ◽

History Of ◽

The Right ◽

Burr Holes

A 69-year-old man first presented to the emergency department after a fall. He had no history of loss of consciousness or vomiting. He sustained a 3 cm long laceration over the right occipital region of the head. There was no fracture in the X-rays of the skull. He was on warfarin because of cardiac problem. He was discharged after suturing. He re-attended the next morning because of left sided weakness. Non-contrast brain computed tomogram showed acute subdural haematoma. Burr holes were performed subsequently. Special precautions should be undertaken in managing the elderly with minor head injury, with a lower threshold for computed tomography and coagulation profile studies.

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Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

Case Reports in Neurology ◽

10.1159/000510845 ◽

2020 ◽

Vol 12 (3) ◽

pp. 433-439

Author(s):

Riwaj Bhagat ◽

Siddharth Narayanan ◽

Marwa Elnazeir ◽

Thong Diep Pham ◽

Robert Paul Friedland ◽

...

Keyword(s):

Systematic Review ◽

Brain Mri ◽

Cranial Nerves ◽

Clinical Manifestations ◽

The Other ◽

Neurological Deficits ◽

Brainstem Stroke ◽

Neurological Features ◽

The Right ◽

Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

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Self-reported sleepiness and not the apnoea hypopnoea index is the best predictor of sleepiness-related accidents in obstructive sleep apnoea

Scientific Reports ◽

10.1038/s41598-020-72430-8 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

P. Philip ◽

S. Bailly ◽

M. Benmerad ◽

J. A. Micoulaud-Franchi ◽

Y. Grillet ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Traffic Accidents ◽

Sleep Apnoea ◽

Near Miss ◽

Cross Sectional ◽

Periodic Leg Movements ◽

Obstructive Sleep ◽

History Of ◽

Respiratory Polygraphy ◽

Sectional Analysis

Abstract To evaluate the value of apnoea + hypopnoea index versus self-reported sleepiness at the wheel in anticipating the risk of sleepiness-related accidents in patients referred for obstructive sleep apnoea. A cross-sectional analysis of the French national obstructive sleep apnoea registry. 58,815 subjects referred for a suspicion of obstructive sleep apnoea were investigated by specific items addressing sleepiness at the wheel and sleepiness-related accidents. Apnoea + hypopnoea index was evaluated with a respiratory polygraphy or full polysomnography. Subjects had a median age of 55.6 years [45.3; 64.6], 65% were men, with a median apnoea + hypopnoea index of 22 [8; 39] events/h. Median Epworth sleepiness scale score was 9 [6; 13], 35% of the patients reported sleepiness at the wheel (n = 20,310), 8% (n = 4,588) reported a near-miss accident and 2% (n = 1,313) reported a sleepiness-related accident. Patients reporting sleepiness at the wheel whatever their obstructive sleep apnoea status and severity exhibited a tenfold higher risk of sleepiness-related accidents. In multivariate analysis, other predictors for sleepiness-related accidents were: male gender, ESS, history of previous near-miss accidents, restless leg syndrome/periodic leg movements, complaints of memory dysfunction and nocturnal sweating. Sleep apnoea per se was not an independent contributor. Self-reported sleepiness at the wheel is a better predictor of sleepiness-related traffic accidents than apnoea + hypopnoea index.

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Giant hyperostosis after sphenoid ridge en plaque meningioma removal

Romanian Neurosurgery ◽

10.2478/romneu-2014-0063 ◽

2014 ◽

Vol 21 (4) ◽

pp. 471-476

Author(s):

Danil Adam ◽

Toma Papacocea ◽

Ioana Hornea ◽

Cristiana Moisescu

Keyword(s):

Brain Mri ◽

Growth Patterns ◽

Neurological Deficits ◽

X Rays ◽

Blurred Vision ◽

Orbital Cavity ◽

Orbital Wall ◽

The Central Nervous System ◽

The Right ◽

Sphenoid Ridge

Abstract Meningioma is in most cases a benign tumor of the central nervous system with two growth patterns: en masse and en plaque. Hyperostosis is associated in 13 - 49 % of the cases with en plaque meningioma. We describe the case of a 47 years old woman with meningotelial sphenoid ridge meningioma which was totally removed. At the first admission she presented with no neurological deficits, seizures and a mild right exophthalmos. This had an indolent growth. After 10 years, the patient was readmitted for headache, blurred vision and right exophthalmos. Skull X-rays and brain MRI revealed an important thickening of the right superior orbit wall and sphenoid ridge. She underwent a new surgery. There was no intradural tumor found. Instead, bones of the superior and lateral right orbit walls were very hiperostotic. A hole of 3/2 cm in the right superior orbital wall was drilled and the orbital cavity was decompressed. In the postoperative period, the symptoms were remitted and the exophthalmos reduced. We discuss the causes and management of hyperostosis associated with meningiomas.

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Primary cerebellar histiocytic sarcoma in a 17-month-old girl

Journal of Neurosurgery Pediatrics ◽

10.3171/2012.5.peds11270 ◽

2012 ◽

Vol 10 (2) ◽

pp. 126-129 ◽

Cited By ~ 9

Author(s):

Kiyoshi Gomi ◽

Mio Tanaka ◽

Mariko Yoshida ◽

Susumu Ito ◽

Masaki Sonoda ◽

...

Keyword(s):

Right Hemisphere ◽

Brain Mri ◽

Histiocytic Sarcoma ◽

Cerebellar Tumor ◽

Pediatric Age Group ◽

Old Japanese ◽

History Of ◽

Dural Attachment ◽

The Right ◽

Aggressive Clinical Course

The authors report on a case of histiocytic sarcoma (HS) in a pediatric patient presenting with a solitary tumor in the cerebellum, with the aim of providing insight into primary HS in the CNS, which is especially rare. A 17-month-old Japanese girl presented with a 2-week history of progressive gait disturbance. Brain MRI revealed a 4.7 × 4.3 × 4.3–cm well-demarcated solitary mass in the right hemisphere of the cerebellum, initially suggestive of medulloblastoma, ependymoma, or anaplastic astrocytoma. On intraoperative inspection the cerebellar tumor showed intensive dural attachment and was subtotally removed. Histological and immunohistochemical findings were consistent with HS. The patient subsequently received chemotherapy, and her preoperative neurological symptoms improved. Primary HS in the CNS usually demonstrates an aggressive clinical course and is currently considered to have a poor prognosis. The possibility of this rare tumor should be included in the differential diagnosis of localized cerebellar tumors in the pediatric age group.

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SAT-270 Priapism Secondary to Cabergoline

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1340 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Maryam Amir ◽

Monica Flores ◽

Jorge Calles-Escandon

Keyword(s):

Side Effect ◽

Penile Erection ◽

Brain Mri ◽

Sella Turcica ◽

Underlying Mechanism ◽

Recent Change ◽

Low Flow ◽

History Of ◽

Long Acting ◽

The Right

Abstract Background: Cabergoline and Bromocriptine are ergot derivative long-acting dopamine agonist that are very effective and well tolerated in patients with hyperprolactinemia. A rare and unwanted side effect of Bromocriptine is priapism, which has hardly ever been report in literature and it’s not cited under the medication insert. The underlying mechanism is not totally clear, but it is well known that dopaminergic pathways in the central nervous system are of importance for male sexual behavior and penile erection. Lesser is known about Cabergoline and priapism with only one case report in the literature (1). Clinical Case: A 65 yr old African American male with a past medical history significant for obesity, essential hypertension, and recent history of frontal headaches was found to have a pituitary macroadenoma. Brain MRI demonstrated 11 x 12 x 9 mm enhancing lesion within the right lateral sella turcica. The lesion extended laterally to abut the right cavernous ICA without vascular encasement or extension into the right temporal skull base. Prolactin level was 276.3 ng/mL (2.1-15.0 ng/mL). He was started on Cabergoline 0.5 mg weekly. 60 days after starting Cabergoline he presented to the ED with a painful penile erection lasting >12 hours. He did not take any Phosphodiesterase (PDE) inhibitors and had no other recent change in medications. He denied any history of sickle cell disease. His most recent dose of Carbergoline was the day prior to the ED visit. He was seen by a Urologist in the ED and confirmed to have a low flow Priapism and underwent aspiration of intracorporal bodies. He was discharged home on pseudoephedrine and pain medications. Carbergoline was discontinued. He has had no further episodes of Priapism since discontinuation of Cabergoline. Conclusion: The time between drug use and occurrence, absence of other offending medications or precipitating factors and no further priapism episodes once treatment was discontinued suggests a priapism as a rarely reported side effect of Cabergoline. (1) References: 1.E.de la Pena Zarzuelo, V. Hernandez Canas and C. Llorente Abarca, Department of Urology, Hospital Universitario Fundacion Alcorcon, Madrid, Spain

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Hypertrophic pachymeningoencephalitis associated with temporal giant cell arteritis

BMJ Case Reports ◽

10.1136/bcr-2018-225304 ◽

2018 ◽

pp. bcr-2018-225304

Author(s):

Gesine Boisch ◽

Sven Duda ◽

Christian Hartmann ◽

Heinrich Weßling

Keyword(s):

Giant Cell Arteritis ◽

Giant Cell ◽

Temporal Arteritis ◽

Brain Mri ◽

Neurological Deficits ◽

High Dose ◽

Immunoglobulin G4 ◽

Perifocal Oedema ◽

History Of ◽

Dose Corticosteroid

We report the rare case of an 80-year-old male patient with hypertrophic pachymeningoencephalitis that may be associated with temporal arteritis. The patient presented to our neurological department with a 2-week history of latent paresis and ataxia affecting his right hand. He had been diagnosed with temporal arteritis 12 years earlier. Brain MRI showed an enhancement of the left-sided frontoparietal meninges with oedema of the adjacent tissue of the precentral and postcentral cortex. A leptomeningeal biopsy was performed. An autoimmune-mediated immunoglobulin G4-associated hypertrophic pachymeningoencephalitis was diagnosed. The patient received a high-dose corticosteroid therapy and his symptoms gradually improved. Our results suggest that hypertrophic pachymeningoencephalitis may occur as a complication of giant cell arteritis and may cause central neurological deficits by cerebral perifocal oedema.

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P061 The effect of anxiety on symptom burden in patients with obstructive sleep apnoea

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.107 ◽

2021 ◽

Vol 2 (Supplement_1) ◽

pp. A41-A41

Author(s):

L Kelley ◽

G Hamilton

Keyword(s):

Obstructive Sleep Apnoea ◽

Functional Outcomes ◽

Depression Scale ◽

Symptom Burden ◽

Severity Index ◽

Sleep Apnoea ◽

Common Symptom ◽

Fatigue Score ◽

Obstructive Sleep ◽

History Of

Abstract Background There is a high prevalence of anxiety in patients with obstructive sleep apnoea and such patients often describe fatigue in addition to sleepiness. We currently use the Epworth Sleepiness Scale (ESS) to quantify sleepiness in our patients, but we do not have useful tools for assessing fatigue. Fatigue is a common symptom in patients with many medical conditions but has not been well studied in patients presenting to sleep services. Our hypothesis is that patients with obstructive sleep apnoea who have a comorbid anxiety disorder, as measured by the Hospital Anxiety and Depression Scale (HADS) are likely to have increased symptom burden such as fatigue or poorer functional outcomes of sleep. Methods Analysis of prospectively collected data from 128 adult patients referred for suspected obstructive sleep apnea to Monash University Health Sleep Clinic. All patients have completed a comprehensive questionnaire prior to their first clinical review assessing their symptom burden at baseline. Questionnaires completed include extensive symptom and medical history assessment, the Fatigue Severity Scale (FSS), ESS, HADS, Functional Outcomes of Sleep Questionnaire (FOSQ), Insomnia Severity Index (ISI) and Global Fatigue Score. All patients were subsequently reviewed by a clinician and have overnight polysomnography data available. Progress to date; Data collected for all 128 participants. Preliminary analysis currently underway. Intended outcome & impact; We intend to examine whether the comorbidity of anxiety results in an increased or different symptom burden in patients referred for suspected obstructive sleep apnoea when compared to patients without a history of anxiety.

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Acute Aneurismal Bilateral Subdural Haematoma without Subarachnoid Haemorrhage: A Case Report and Review of the Literature

Case Reports in Neurological Medicine ◽

10.1155/2014/260853 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 3

Author(s):

Ossama Mansour ◽

Tamer Hassen ◽

Sameh Fathy

Keyword(s):

Case Report ◽

Subarachnoid Haemorrhage ◽

Cerebral Aneurysm ◽

Subdural Haematoma ◽

Neurological Status ◽

Review Of The Literature ◽

Acute Subdural Haematoma ◽

History Of ◽

High Level

Spontaneous pure acute bilateral subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. It can follow rupture of different aneurysms specially located in anterior incisural space; the most frequently encountered location is the PcoA aneurysms as demonstrated in the present case. We present a case report of a PcoA aneurysm presenting as pure bilateral ASDH. A high level of suspicion for bleeding of arterial origin should be maintained in all cases of acute subdural haematoma without history of trauma. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations.

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“Unusual brain stone”: heavily calcified primary neoplasm with some features suggestive of angiocentric glioma

Journal of Neurosurgery ◽

10.3171/2014.11.jns131158 ◽

2015 ◽

Vol 123 (5) ◽

pp. 1256-1260 ◽

Cited By ~ 1

Author(s):

Jahangir Sajjad ◽

Chandrasekaran Kaliaperumal ◽

Niamh Bermingham ◽

Charles Marks ◽

Catherine Keohane

Keyword(s):

Ct Scan ◽

Neurological Deficits ◽

Parietal Region ◽

History Of ◽

Angiocentric Glioma ◽

Primary Neoplasm ◽

History Of Epilepsy ◽

The Right ◽

Visual Blurring ◽

Excised Tissue

This 40-year-old man presented with a 5-month history of progressive right-sided headache associated with visual blurring. He also had a history of epilepsy but had been seizure free with medication for the past 10 years. An initial CT scan of his brain performed 16 years previously had revealed a small area of calcification in the right parietal region. In the current presentation, he had a left-sided homonymous hemianopia but no other neurological deficits. A CT scan of his brain showed a much larger calcified, partly cystic lesion in the right parietal region. Because he was symptomatic, the lesion was excised and the cyst was drained. Histological examination of the excised tissue showed an unusual primary tumor that was difficult to classify but had some features of angiocentric glioma. The heavy calcification, mixed-density cell population, and regions with features of angiocentric glioma were most unusual. The patient remained asymptomatic 5 years after surgery, and follow-up scans did not show recurrence.

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