Reversible Foix-Chavany-Marie syndrome after right operculo-insular contusion from a spear gun trauma through the cranial base

2018 ◽  
Vol 2 (1) ◽  
pp. 30-33
Author(s):  
Marcus André Acioly ◽  
Marcílio Diogo de Oliveira Barbosa ◽  
Rosemary Tavares Pontes ◽  
Marcos Müller ◽  
Guilherme Brasileiro de Aguiar
Keyword(s):  
Cranial Base ◽  
Severe Form ◽  
Pseudobulbar Palsy ◽  
Facial Weakness ◽  
Rare Type ◽  
Submandibular Region ◽  
Vessel Injury ◽  
Major Vessel ◽  
Gag Reflex

Abstract Background and object Foix-Chavany-Marie syndrome (FCMS) is a rare type of pseudobulbar palsy, which is characterized by anarthria or severe dysarthria and bilateral central facio-linguo-velo-pharyngo-mastigatory paralysis with “automatic voluntary dissociation”. We report on a patient who suffered a reversible FCMS following a spear gun trauma through the cranial base leading to right operculo-insular contusion. Case Report This 28-year-old lady attempted suicide by shooting a spear gun into the head through her right submandibular region. Major vessel injury was ruled out and the patient was taken to the operating room for shaft removal. Postoperatively, we observed the mouth half open, drooling saliva, inability to move her tongue, anarthria, bilateral facial weakness, and loss of the gag reflex. Yawning was otherwise preserved resulting in a clinical diagnosis of FCMS. Postoperative imaging demonstrated a right operculoinsular contusion. Symptoms were fully recovered after two years of follow-up. Conclusion FCMS is a rare and severe form of pseudobulbar palsy. Unilateral lesions are exceptional but should be recognized, as we presented. Generally, the outcome is moderate to poor but the occurrence in brain trauma can be associated with complete functional recovery.

A retrospective analysis of pedicle screws in contact with the great vessels

2010 ◽  
Vol 13 (3) ◽  
pp. 403-406 ◽  
Author(s):  
Kenneth C. Foxx ◽  
Roy C. Kwak ◽  
Jonathan M. Latzman ◽  
Uzma Samadani
Keyword(s):  
Patient Outcomes ◽  
Asymptomatic Patient ◽  
Vena Cava ◽  
Pedicle Screws ◽  
Postoperative Imaging ◽  
Vessel Injury ◽  
Major Vessel ◽  
Great Vessels ◽  
Screw Penetration

Object Pedicle screws placed in the thoracic, lumbar, and sacral spine occasionally come in contact with the aorta, vena cava, or iliac vessels. When such screws are seen on postoperative imaging in an asymptomatic patient, the surgeon must decide whether it is riskier to revise the screw or to observe it. The authors hypothesized that the incidence of screw placement causing perioperative vessel injury is low and, further, that screws placed in contact with major vessels do not always result in vessel injury. Methods A retrospective review of the operative records of 182 consecutive patients undergoing thoracic, lumbar, and lumbosacral pedicle screw fusion was performed to determine the frequency of intraoperative vessel injury. Postoperative imaging for 107 patients was available to determine the incidence of screws in contact with major vessels. Charts were examined to determine if any adverse sequelae had resulted from malpositioned screws. Patient outcomes were documented. Results There were no intraoperative vessel injuries or deaths in 182 consecutive operations. One hundred seven patients with available postoperative films had 680 pedicle screws placed between T-3 and the sacrum during 115 operations. No patient had arterial screw penetration or deformation on postoperative imaging. Thirty-three of the 680 inserted screws were in contact with a major vessel on routine postoperative imaging. The contacted vessels included the aorta (4 cases), the iliac artery (7 cases), and the iliac veins (22 cases). Patients were followed up until death or November 2009, for a mean follow-up of 44 months (median 44 months, range 5–109 months). None of the patients with vessel contact was noted to suffer symptoms or sequelae as a result of vessel contact. Radiographic follow-up as long as 50 months after surgery revealed no detectable vessel abnormality at the contacted site. Conclusions Placing pedicle screws in contact with major vessels is a known risk of spinal surgery. The risk of repositioning a screw in contact with a major vessel but causing no symptoms must be weighed against the relative risk of leaving it in place.

scholarly journals Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene

2021 ◽  
Vol 9 ◽  
pp. 205031212110291
Author(s):  
Targ Elgzyri ◽  
Jan Apelqvist ◽  
Eero Lindholm ◽  
Hedvig Örneholm ◽  
Magdalena Annersten Gershater
Keyword(s):  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Foot Ulcer ◽  
Major Amputation ◽  
Severe Form ◽  
Foot Ulcers ◽  
Vascular Intervention ◽  
Co Morbidity ◽  
Patients With Diabetes

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3–234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35–95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3–234) weeks; for auto-amputated, 48 (10–228) weeks; for minor amputated, 48 (6–234) weeks; and for major amputation, 32 (3–116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

scholarly journals Hybrid treatment of fibroadipose vascular anomaly: A case report

Open Medicine ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 890-897
Author(s):  
Francesco Stillo ◽  
Federica Ruggiero ◽  
Antonio De Fiores ◽  
Rita Compagna ◽  
Bruno Amato
Keyword(s):  
Patient Satisfaction ◽  
Vascular Anomaly ◽  
Rare Type ◽  
Complete Excision ◽  
Hybrid Treatment ◽  
Constant Pain ◽  
Additional Surgery ◽  
Ethanol Embolization

AbstractBackgroundFirst identified in 2014, fibroadipose vascular anomaly (FAVA) is a very rare type of venous and lymphatic malformation. Marked by tough fibrofatty tissue in the extremities overtaking portions of the muscles, it is associated with constant pain and contracture of the affected extremity. There is a paucity of literature, and no guidelines on treatment procedure are available. This case highlights the role of hybrid treatment with primary ethanol percutaneous ethanol embolization and additional surgery for radicality in excision of FAVA lesions.Case summaryA 9-year-old girl with FAVA underwent the hybrid treatment. The achievements of complete excision, clinical response, and patient satisfaction in long-term follow-up were assessed. Following the hybrid treatment, the patient experienced significant improvement in pain. Concurrent symptoms of physical limitation, leg swelling, and skin hyperesthesia also improved. The clinical benefit, supported by postoperative physiotherapy, was well stabilized at 6-month follow-up, resulting in complete patient satisfaction at 12- and 36-month follow-ups. No major complications were encountered.ConclusionEthanol embolization plus surgery is a safe, effective, and long-term hybrid treatment of symptomatic FAVA lesions.

scholarly journals A framework for the evaluation of patients with congenital facial weakness

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Bryn D. Webb ◽  
Irini Manoli ◽  
Elizabeth C. Engle ◽  
Ethylin W. Jabs
Keyword(s):  
Genetic Counseling ◽  
Genetic Testing ◽  
Patient Population ◽  
Clinical Care ◽  
Diagnostic Algorithm ◽  
Accurate Diagnosis ◽  
Facial Weakness ◽  
The Core ◽  
Follow Up Studies

AbstractThere is a broad differential for patients presenting with congenital facial weakness, and initial misdiagnosis unfortunately is common for this phenotypic presentation. Here we present a framework to guide evaluation of patients with congenital facial weakness disorders to enable accurate diagnosis. The core categories of causes of congenital facial weakness include: neurogenic, neuromuscular junction, myopathic, and other. This diagnostic algorithm is presented, and physical exam considerations, additional follow-up studies and/or consultations, and appropriate genetic testing are discussed in detail. This framework should enable clinical geneticists, neurologists, and other rare disease specialists to feel prepared when encountering this patient population and guide diagnosis, genetic counseling, and clinical care.

scholarly journals Carcinosarcomas of the larynx: systematic review of the literature of a rare nosologic entity

2021 ◽  
Author(s):  
Andrea Colizza ◽  
Antonio Gilardi ◽  
Antonio Greco ◽  
Fabrizio Cialente ◽  
Federica Zoccali ◽  
...  
Keyword(s):  
Overall Survival ◽  
Data Extraction ◽  
Treatment Guideline ◽  
Cancer Staging ◽  
Spindle Cell Carcinoma ◽  
Nodal Metastasis ◽  
Partial Laryngectomy ◽  
Rare Type ◽  
Rare Malignancy

Abstract Purpose Carcinosarcoma, also known as Spindle Cell Carcinoma (SpCC), is a rare type of malignant tumor. Generally, this type of pathology occurs in the urogenital tract, the gastrointestinal tract, respiratory tract and mammary gland; in the larynx, SpCC represents only 2–3% of all malignancies. Due to its rarity, there is currently no generally acceptable treatment guideline for this disease. The aim of this study was to systematically review the literature of SpCC of larynx and report epidemiologic, clinicopathologic and main therapeutic approaches for this entity. Methods A systematic literature review was performed using MEDLINE, EMBASE, PubMed and Scopus databases. For this review, the results were extrapolated in the period between January 1990 to September 2020. Data extraction was performed using a standard registry database. The clinical and pathological staging were recalculated according to the Eight Edition of AJCC Cancer Staging Manual and statistical analyses were performed using SPSS Version 25.0. Results A total of 111 patients affected by laryngeal carcinosarcoma were included. From our review arises that surgery is the main treatment for primary laryngeal carcinosarcoma. In this way, various techniques such as minimally invasive laryngoscopy excision, laser CO2 cordectomy, partial laryngectomy (vertical and horizontal) and total laryngectomy. The role of radiotherapy is still controversial. The overall survival (OS) for T1 stage tumor at 5 years of follow-up is 82.9%, the OS for T2 and T3 tumor is 74% and 73.4%. The OS at 5 years of follow-up is 91.7% for supraglottic tumor, 69.3% for glottic tumor and 50% for transglottic site. Subglottic site is described in only 2 cases [12–13], so the OS at 5 years is not statistically significant. The 5-year overall survival in patients without lymph nodes involvement (N0) is 90.2%, 66.7% and 50%, respectively, for N1 and N2 lesions. Conclusion Primary laryngeal carcinosarcoma is a very rare malignancy. There are no clear guidelines in the management but in the literature, surgery is described as the best modality of therapy; radiation only can be a reasonable alternative with controversial efficacy. The most important prognostic factor is the nodal metastasis.

Eosinophilic Granuloma of the Clivus: Case Report, Follow-up of Two Previously Reported Cases, and Review of the Literature on Cranial Base Eosinophilic Granuloma

Neurosurgery ◽  
1997 ◽  
Vol 41 (1) ◽  
pp. 273-279 ◽  
Author(s):  
Jonathan L. Brisman ◽  
Neil A. Feldstein ◽  
Nancy J. Tarbell ◽  
Douglas Cohen ◽  
Abba L. Cargan ◽  
...  
Keyword(s):  
Case Report ◽  
Eosinophilic Granuloma ◽  
Cranial Base ◽  
Review Of The Literature

scholarly journals Pulmonary Artery Perforation: Rare reported Complication of Pericardiectomy for Chronic Constrictive Pericarditis recorded on Transesophageal Echocardiography

2016 ◽  
Vol 4 (1) ◽  
pp. 17-18
Author(s):  
Sameer Taneja ◽  
Jitin Narula ◽  
Neeti Makhija ◽  
Milind P Hote
Keyword(s):  
Pulmonary Artery ◽  
Transesophageal Echocardiography ◽  
Constrictive Pericarditis ◽  
Main Pulmonary Artery ◽  
Iatrogenic Injury ◽  
Surgical Team ◽  
Vessel Injury ◽  
Major Vessel ◽  
Pulmonary Artery Perforation

ABSTRACT Major vessel injury is a possible complication during pericardiectomy for chronic constrictive pericarditis (CCP). We present a case of CCP, who while undergoing radical pericardiectomy incurred an iatrogenic injury of a major vessel with profuse bleeding. A rent in main pulmonary artery (MPA) was detected by the surgical team and simultaneously confirmed on transesophageal echocardiography (TEE), and a timely intervention was done. Importance of monitoring TEE in a patient undergoing pericardiectomy for CCP is highlighted. How to cite this article Makhija N, Narula J, Kumar S, Taneja S, Hote MP. Pulmonary Artery Perforation: Rare reported Complication of Pericardiectomy for Chronic Constrictive Pericarditis recorded on Transesophageal Echocardiography. J Perioper Echocardiogr 2016;4(1):17-18.

Gamma Knife radiosurgery for skull base meningioma: long-term results of low-dose treatment

2008 ◽  
Vol 109 (5) ◽  
pp. 804-810 ◽  
Author(s):  
Yoshiyasu Iwai ◽  
Kazuhiro Yamanaka ◽  
Hidetoshi Ikeda
Keyword(s):  
Malignant Transformation ◽  
Gamma Knife ◽  
Low Dose ◽  
Gamma Knife Radiosurgery ◽  
Cranial Base ◽  
Local Failure ◽  
Long Term Results ◽  
Early Results

Object In this study, the authors evaluate the long-term results after Gamma Knife radiosurgery of cranial base meningiomas. This study is a follow-up to their previously published report on the early results. Methods Between January 1994 and December 2001, the authors treated benign cranial base meningiomas in 108 patients using low-dose Gamma Knife radiosurgery. The tumor volumes ranged from 1.7 to 55.3 cm3 (median 8.1 cm3), and the radiosurgery doses ranged from 8 to 12 Gy (median 12 Gy) to the tumor margin. Results The mean duration of follow-up was 86.1 months (range 20–144 months). Tumor volume decreased in 50 patients (46%), remained stable in 51 patients (47%), and increased (local failure) in 7 patients (6%). Eleven patients experienced tumor recurrence outside the treatment field. Among these patients, marginal failure was seen in 5 and distant recurrence was seen in 6. Seven patients were thought to have malignant transformation based on histological or radiological characteristics of the lesion. The actuarial progression-free survival rate, including malignant transformation and outside recurrence, was 93% at 5 years and 83% at 10 years. Neurological status improved in 16 patients (15%). Permanent radiation injury occurred in 7 patients (6%). Conclusions Gamma Knife radiosurgery is a safe and effective treatment for cranial base meningiomas as demonstrated with a long-term follow-up period of > 7 years. Surgeons must be aware of the possibility of treatment failure, defined as local failure, marginal failure, and malignant transformation; however, this may be the natural course of meningiomas and not related to radiosurgery.

Abstract WP43: Diffusion and T2 Star Weighted MR Angiography Mismatch Predicts Ischemic Penumbra in the Acute Stage

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Susumu Yamaguchi ◽  
Nobutaka Horie ◽  
Yohei Tateishi ◽  
MInoru Morikawa ◽  
Kazuhiko Suyama ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Contrast Media ◽  
Mr Angiography ◽  
Acute Stage ◽  
The Other ◽  
Unknown Etiology ◽  
Ischemic Penumbra ◽  
Vessel Occlusion ◽  
Major Vessel

Background and purpose: T2 star weighted MR angiography (SWAN) can detect hemodynamic insufficiency as hypointensity areas in the medullary or cortical veins. In this study, we investigate whether SWAN in 1.5T MRI can help to detect ischemic penumbra-like lesions in acute ischemic stroke (AIS) patients. Materials and methods: Patients showing acute major vessel occlusion (ICA and MCA) within 4.5 hours from onset were consecutively analyzed with MRI including SWAN, DWI, and MRA. To evaluate ischemic area in SWAN and DWI, modified ASPECT (mASPECTS) were used. SWAN- and DWI- based mASPECTS was calculated, and correlation between DWI-SWAN mismatch and final infarct lesion or outcome was evaluated. Results: Thirty-five patients were included in this study. Of the 35 patients (mean age: 73.5 ± 13.5 years), cardioembolic stroke was confirmed in 26 patients, atherothrombotic stroke was in 4 patients, and the others had unknown etiology. Overall, recanalization was achieved in 23 patients (65%), showing higher mASPECTS in follow up DWI and lower mRS at 90 days than patients with no recanalization ( P =0.037 and P <0.001). Initial SWAN-based mASPECTS and follow-up DWI-based mASPECTS were both significantly higher in atherothrombotic stroke than in cardiogenic stroke ( P =0.016 and P =0.042). Of 12 patients showing no recanalization, DWI-SWAN mismatch was significantly correlated with infarct growth (R 2 =0.6160, P =0.0025). On the other hand, there was no such correlation for patients showing recanalization. Interestingly, initial SWAN-based mASPECTS was significantly correlated with mRS at 90 days (R=-0.38, P =0.037) regardless of recanalization. Conclusions: DWI-SWAN mismatch in 1.5T MRI could show penumbra-like lesions in AIS patients with major vessel occlusion. Low mASPECTS in initial SWAN might predict unfavorable outcome. Assessment of ischemic penumbra from venous side using SWAN can visualize a lesion’s viable tissue and is quite useful without contrast media.

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