Pyogenic Ventriculitis Associated with Urosepsis: A Rare Case Report

European Journal of Case Reports in Internal Medicine ◽

10.12890/2020_002178 ◽

2020 ◽

Author(s):

Joana Correia Lopes ◽

Andreia Sofia Basílio ◽

Mário Amaro

Keyword(s):

Neurological Deficits ◽

Resonance Imaging ◽

Cerebral Ventricles ◽

E Coli ◽

Clinical Challenge ◽

Level Of Consciousness ◽

Rare Case Report ◽

History Of ◽

G 12

Pyogenic ventriculitis is an infection of the cerebral ventricles usually associated with neurosurgery or head trauma. There are less than 10 reported cases of community-acquired pyogenic ventriculitis in adults. We present the case of a 71-year-old man with a medical history of type 2 diabetes mellitus, hospitalized due to urosepsis caused by E. coli. Because he had a fluctuant level of consciousness, he underwent magnetic resonance imaging that diagnosed pyogenic ventriculitis. He was treated with ceftriaxone 2 g 12/12h for a total of 6 weeks and recovered without neurological deficits. Pyogenic ventriculitis is a clinical challenge due to its rarity, atypical presentation and variety of aetiological microorganisms.

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Interaction between methadone and clarithromycin as the suspected cause of an opioid toxidrome

BMJ Case Reports ◽

10.1136/bcr-2020-240647 ◽

2021 ◽

Vol 14 (5) ◽

pp. e240647

Author(s):

Blair Wallace ◽

Daniel Edwardes ◽

Christian Subbe ◽

Muhammed Murtaza

Keyword(s):

Respiratory Failure ◽

Community Acquired Pneumonia ◽

Opiate Dependence ◽

Pleuritic Chest Pain ◽

Once Daily ◽

High Importance ◽

Level Of Consciousness ◽

The World ◽

History Of

A 40-year-old patient was admitted through the acute medical take with pleuritic chest pain and rigours. He had a medical history of opiate dependence and was receiving 60 mg of methadone once daily. He was diagnosed with a community-acquired pneumonia and treated with amoxicillin and clarithromycin. After administration of only two concomitant doses of methadone and oral clarithromycin, he developed an opioid toxidrome with type-2 respiratory failure, a decreased level of consciousness and pinpoint pupils. The patient was treated with naloxone and his symptoms improved. Retrospectively, it was suspected that an interaction between clarithromycin and methadone might have contributed to the toxidrome. Respiratory failure has not been previously prescribed for this combination of medication and is of high importance for physicians and pharmacists around the world.

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Multifocal granulocytic sarcoma of the spine mimicking neurofibromatosis Type 2: case report

Journal of Neurosurgery Spine ◽

10.3171/2016.2.spine151044 ◽

2016 ◽

Vol 25 (4) ◽

pp. 523-527

Author(s):

Gregory P. Lekovic ◽

Marc S. Schwartz ◽

John L. Go

Keyword(s):

Granulocytic Sarcoma ◽

Neurofibromatosis Type ◽

Rapid Onset ◽

Neurofibromatosis Type 2 ◽

Neurological Deficits ◽

Lumbosacral Spine ◽

Imaging Features ◽

History Of ◽

Patient’S History

In this report the authors report on a patient with a very indolent course of granulocytic sarcoma, characterized by steroid-induced remission of spinal and cranial tumors and recurrence over a period of several years. This 24-year-old man with history of leukemia presented with rapid-onset quadriparesis secondary to multiple extraaxial masses of the cervicothoracic spine, from C-5 to T-3, and lumbosacral spine, from L-5 to the coccyx. Although the imaging features were highly suggestive of neurofibromatosis Type 2, the patient's history and clinical course were consistent with granulocytic sarcoma; repeat imaging and, later, needle biopsy definitively established the diagnosis of granulocytic sarcoma. Laminectomy and surgical decompression of the spine were not required and, arguably, could have posed unnecessary risk to the patient. This case illustrates that the successful management of a patient presenting with profound neurological deficits due to intradural spinal cord tumors may sometimes be nonsurgical.

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Stereotactic Radiosurgery of Angiographically Occult Vascular Malformations: Indications and Preliminary Experience

Neurosurgery ◽

10.1227/00006123-199012000-00006 ◽

1990 ◽

Vol 27 (6) ◽

pp. 892-900 ◽

Cited By ~ 89

Author(s):

Douglas Kondziolka ◽

L. Dade Lunsford ◽

Robert J. Coffey ◽

David J. Bissonette ◽

John C. Flickinger

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Stereotactic Radiosurgery ◽

Vascular Malformations ◽

Neurological Deficits ◽

Resonance Imaging ◽

University Of Pittsburgh ◽

History Of ◽

The Brain

Abstract Stereotactic radiosurgery has been shown to treat successfully angiographically demonstrated arteriovenous malformations of the brain. Angiographic obliteration has represented cure and eliminated the risk of future hemorrhage. The role of radiosurgery in the treatment of angiographically occult vascular malformations (AOVMs) has been less well defined. In the initial 32 months of operation of the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 24 patients meeting strict criteria for high-risk AOVMs were treated. Radiosurgery was used conservatively; each patient had sustained two or more hemorrhages and had a magnetic resonance imaging-defined AOVM located in a region of the brain where microsurgical removal was judged to pose an excessive risk. Venous angiomas were excluded by performance of high-resolution subtraction angiography in each patient. Fifteen malformations were in the medulla, pons, and/or mesencephalon, and 5 were located in the thalamus or basal ganglia. Follow-up ranged from 4 to 24 months. Nineteen patients either improved or remained clinically stable and did not hemorrhage again during the follow-up interval. One patient suffered another hemorrhage 7 months after radiosurgery. Five patients experienced temporary worsening of pre-existing neurological deficits that suggested delayed radiation injury. Magnetic resonance imaging demonstrated signal changes and edema surrounding the radiosurgical target. Dose-volume guidelines for avoiding complications were constructed. Our initial experience indicates that stereotactic radiosurgery can be performed safely in patients with small, well-circumscribed AOVMs located in deep, critical, or relatively inaccessible cerebral locations. Because cerebral angiography is not useful in following patients with AOVMs, long-term magnetic resonance imaging and clinical studies will be necessary to determine whether the natural history of such lesions is changed by radiosurgery.

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Ruptured giant aneurysm of a cortical middle cerebral artery: A case report

Surgical Neurology International ◽

10.25259/sni_952_2020 ◽

2021 ◽

Vol 12 ◽

pp. 95

Author(s):

Samer S. Hoz ◽

Zaid Aljuboori ◽

Sajaa A. Albanaa ◽

Zahraa F. Al-Sharshahi ◽

Mohammed A. Alrawi ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Giant Aneurysm ◽

Neurological Deficits ◽

Intracerebral Hematoma ◽

Microsurgical Clipping ◽

Level Of Consciousness ◽

History Of ◽

Posterior Parietal ◽

Mca Aneurysm

Background: Aneurysms of the cortical branches of the middle cerebral artery (MCA) are rare. They usually are secondary to traumatic or infectious etiologies and are rarely idiopathic. The specific characteristics of idiopathic aneurysms in such location are not well defined in the literature. The authors report a rare case of a ruptured giant idiopathic cortical MCA aneurysm with review of the available literature on this clinical entity. Case Description: A 24-year-old female presented with headache, disturbed level of consciousness, and right-sided weakness. Imaging studies showed a left frontoparietal intracerebral hematoma and a giant saccular aneurysm in the posterior parietal cortical branch of the MCA. The patient had no history of head trauma or active infection; therefore, the aneurysm was considered idiopathic. A microsurgical clipping of the aneurysm with evacuation of the hematoma was performed. There were no surgical complications, and the patient achieved a good outcome modified Rankin Scale of 1 with no neurological deficits. Conclusion: Idiopathic aneurysms of the cortical branches of the MCA are rare, and usually present with intraparenchymal hemorrhage due to rupture. There is no clear consensus regarding the optimal management strategy. This case shows that timely management can lead to good outcomes.

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FEMORAL-FACIAL SYNDROME - A RARE CASE REPORT

10.36106/gjra/3201392 ◽

2021 ◽

pp. 34-35

Author(s):

Kinjal Patel ◽

Pragya Chaturvedi ◽

Anu Bhandari

Keyword(s):

Varus Deformity ◽

Maternal Diabetes ◽

Female Child ◽

Lower Limbs ◽

Fetal Malformation ◽

Left Femur ◽

Craniofacial Dysmorphism ◽

Rare Case Report ◽

History Of

Femoral-facial syndrome (FFS) is an extremely rare fetal malformation. It comprises bilateral femoral hypoplasia and craniofacial dysmorphism. Maternal diabetes is associated with approximately 40% of cases of FFS. We present the case of Femoral-Facial syndrome of Newborn female child. She was delivered by vaginal route at 36th week of gestation. Mother had a history of type 2 diabetes mellitus. She was having markedly shortened bilateral lower limbs, deformed hip joint and mild talipes equino-varus deformity of left foot. There was prominent forehead, short nose with broad tip, long philthrum, thin upper lip, micrognathism and malformed low set external ears. Skeletal radiograph shows complete absence of right femur and marked hypoplasia of left femur.

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Intradural Cervical Lipoma in a Neurologically Intact Patient: Case Report

Neurosurgery ◽

10.1227/00006123-199109000-00027 ◽

1991 ◽

Vol 29 (3) ◽

pp. 468-472 ◽

Cited By ~ 13

Author(s):

Robert F. Heary ◽

Yashwant Bhandari

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Case Report ◽

Cervical Spinal Cord ◽

Neurological Deficits ◽

Resonance Imaging ◽

Patient Case ◽

Previous Trauma ◽

History Of ◽

Neurologically Intact

Abstract The authors report an unusual intradural subpial lipoma of the cervical spinal cord in a neurologically intact adolescent. The patient sought treatment for neck pain and had a history of previous trauma. Magnetic resonance imaging revealed the lesion. There are no reported cases of a subpial lipoma detected in the absence of any neurological deficits. A subtotal excision was performed, and pathological studies confirmed the diagnosis. Postoperatively, the patient remained neurologically intact.

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Traumatic interdural arachnoid cyst in the upper cervical spine

Journal of Neurosurgery ◽

10.3171/jns.1996.85.2.0351 ◽

1996 ◽

Vol 85 (2) ◽

pp. 351-353 ◽

Cited By ~ 24

Author(s):

Han-Jung Chen ◽

Leung Chen

Keyword(s):

Cervical Spine ◽

Arachnoid Cyst ◽

Neurological Deficits ◽

Upper Cervical Spine ◽

Resonance Imaging ◽

Content Type ◽

Upper Cervical ◽

History Of ◽

Traumatic Origin ◽

Progressive Weakness

✓ The case of an interdural arachnoid cyst of traumatic origin at the C3–5 level in an 18-year-old man was admitted to our hospital with a 1-year history of progressive weakness in left limbs and numbness below the clavicles is reported. He had had a C-2 fracture at the age of 9 years without definite neurological deficits. Magnetic resonance imaging revealed a cystic lesion in the C3–5 level. Laminectomy was performed, and an interdural cyst was found. Histological examination revealed fibrous thickening of the arachnoid membrane. A cyst located in the interdural space of upper cervical spine is extremely rare.

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Acute Syringomyelia: Case Report

Neurosurgery ◽

10.1227/01.neu.0000088809.14965.00 ◽

2003 ◽

Vol 53 (5) ◽

pp. 1220-1222 ◽

Cited By ~ 20

Author(s):

Thomas H. Milhorat ◽

Paolo A. Bolognese ◽

Karen S. Black ◽

Rona F. Woldenberg

Keyword(s):

Magnetic Resonance Imaging ◽

Spinal Cord ◽

Magnetic Resonance ◽

Ventriculoperitoneal Shunt ◽

Central Canal ◽

Chiari I Malformation ◽

Neurological Deficits ◽

Resonance Imaging ◽

History Of ◽

Communicating Syringomyelia

Abstract OBJECTIVE AND IMPORTANCE Syringomyelia is generally regarded as a chronic, slowly progressive disorder. We describe a case of acute dilation of the central canal of the spinal cord that presented with rapidly progressive segmental signs. CLINICAL PRESENTATION A 29-year-old female patient who had previously undergone surgical treatment for a Chiari I malformation, syringomyelia, and hydrocephalus presented with an 8-day history of headaches, progressive paraparesis, and urinary retention. Magnetic resonance imaging scans demonstrated panventricular hydrocephalus in association with a holocord syrinx that extended to the obex. Magnetic resonance imaging scans that had been coincidentally obtained just 3 days before the onset of symptoms had revealed no evidence of hydrocephalus or syringomyelia. INTERVENTION The patient underwent emergency revision of a failed ventriculoperitoneal shunt. Postoperatively, there was prompt resolution of the syringomyelia, hydrocephalus, and associated neurological deficits. CONCLUSION Among patients with communicating syringomyelia, the central canal of the spinal cord participates as a “fifth ventricle” and can undergo rapid dilation in association with acute hydrocephalus. Appropriate treatment in such cases involves placement of a ventriculoperitoneal shunt.

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