scholarly journals Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review

2015 ◽  
Vol 38 (4) ◽  
pp. E3 ◽  
Author(s):  
Anil K. Roy ◽  
_ _ ◽  
Brandon A. Miller ◽  
Christopher M. Holland ◽  
Arthur J. Fountain ◽  
...  
Keyword(s):  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Spinal Column ◽  
Case Series ◽  
Craniovertebral Junction ◽  
Significant Heterogeneity ◽  
Case Review ◽  
Ligamentous Injury ◽  
Mri Findings ◽  
Retrospective Case

OBJECT The craniovertebral junction (CVJ) is unique in the spinal column regarding the degree of multiplanar mobility allowed by its bony articulations. A network of ligamentous attachments provides stability to this junction. Although ligamentous injury can be inferred on CT scans through the utilization of craniometric measurements, the disruption of these ligaments can only be visualized directly with MRI. Here, the authors review the current literature on MRI evaluation of the CVJ following trauma and present several illustrative cases to highlight the utility and limitations of craniometric measures in the context of ligamentous injury at the CVJ. METHODS A retrospective case review was conducted to identify patients with cervical spine trauma who underwent cervical MRI and subsequently required occipitocervical or atlantoaxial fusion. Craniometric measurements were performed on the CT images in these cases. An extensive PubMed/MEDLINE literature search was conducted to identify publications regarding the use of MRI in the evaluation of patients with CVJ trauma. RESULTS The authors identified 8 cases in which cervical MRI was performed prior to operative stabilization of the CVJ. Craniometric measures did not reliably rule out ligamentous injury, and there was significant heterogeneity in the reliability of different craniometric measurements. A review of the literature revealed several case series and descriptive studies addressing MRI in CVJ trauma. Three papers reported the inadequacy of the historical Traynelis system for identifying atlantooccipital dislocation and presented 3 alternative classification schemes with emphasis on MRI findings. CONCLUSIONS Recognition of ligamentous instability at the CVJ is critical in directing clinical decision making regarding surgical stabilization. Craniometric measures appear unreliable, and CT alone is unable to provide direct visualization of ligamentous injury. Therefore, while the decision to obtain MR images in CVJ trauma is largely based on clinical judgment with craniometric measures used as an adjunct, a high degree of suspicion is warranted in the care of these patients as a missed ligamentous injury can have devastating consequences.

Ewing’s Sarcoma of the Hand

2008 ◽  
Vol 34 (1) ◽  
pp. 35-39 ◽  
Author(s):  
O. A. ANAKWENZE ◽  
W. L. PARKER ◽  
L. E. WOLD ◽  
K. K AMRAMI ◽  
P. C. AMADIO
Keyword(s):  
Radiation Therapy ◽  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Case Series ◽  
Surgical Excision ◽  
Case Review ◽  
Retrospective Case ◽  
Postoperative Radiation Therapy ◽  
Definitive Surgery

A retrospective case review was carried out to report the outcomes in a contemporary case series of Ewing’s sarcoma originating in the hand. We identified five patients treated since 1995. All five had wide surgical excision, one by ray amputation. All were treated with chemotherapy. Four patients also received radiation therapy, two to treat metastases and two as an adjunct to local excision. There were no local recurrences. Two patients developed metastases. Both died of their disease. Neither of these two patients had received local postoperative radiation therapy; one did not receive chemotherapy before definitive surgery. The other three patients were alive and free of disease at last follow-up, 4 to 12 years after initial presentation.

Defining failure after parathyroidectomy for primary hyperparathyroidism: case series

2011 ◽  
Vol 125 (4) ◽  
pp. 394-398
Author(s):  
S D Charlett ◽  
M Aye ◽  
S L Atkin ◽  
R J A England
Keyword(s):  
Primary Hyperparathyroidism ◽  
Outcome Measure ◽  
Case Series ◽  
Case Review ◽  
Cure Rate ◽  
Retrospective Case ◽  
Diagnostic Uncertainty ◽  
Primary Surgery ◽  
Primary Procedure ◽  
Cause Of Failure

AbstractObjective:To identify the cause of operative failure in patients who have undergone parathyroid surgery for primary hyperparathyroidism.Design:Retrospective case review.Participants:Patients who had undergone a primary procedure for primary hyperparathyroidism between July 2003 and December 2007. Cases with incomplete post-operative serum calcium data were excluded.Main outcome measure:Operative failure was defined as failure to achieve normalisation of serum adjusted calcium levels post-operatively.Results:A total of 220 primary procedures were conducted over 4.5 years. Data were not available for 16 patients. Thirteen procedures (6.4 per cent) were considered failures, and these cases were individually reviewed and classified according to the reason for failure.Conclusion:Establishing the cause of failure following surgery for primary hyperparathyroidism can be a complex task. In some instances, diagnostic uncertainty remains despite detailed biochemical and radiological assessment. This paper outlines our approach to maximising the cure rate at primary surgery.

Causative agents of liver abscess in HIV-seropositive patients: a 10-year case series in Thai hospitalized patients

2005 ◽  
Vol 35 (2) ◽  
pp. 115-115 ◽  
Author(s):  
Viroj Wiwanitkit
Keyword(s):  
Liver Abscess ◽  
Case Series ◽  
Gastrointestinal Disorder ◽  
High Rate ◽  
Amoebic Liver Abscess ◽  
Case Review ◽  
Retrospective Case ◽  
Gram Negative ◽  
Positive Bacterial Culture ◽  
Hiv Seropositive

Liver abscess is an important tropical gastrointestinal disorder. HIV seropositive patients show relative immunosuppression and are more susceptible to infection, including liver abscess. This retrospective case review was made on 23 patients who were diagnosed as HIV seropositive with liver abscess in Bangkok, Thailand. We demonstrated the high rate of amoebic liver abscess in our series (17.4%) from fresh smear with five cases of tuberculosis and one case of Nocardosis. The rates of positive bacterial culture were 17.4% from blood and 47.8% from pus. Gram-negative aerobes were the major abscess pathogens in our series. Among Gram-negative aerobes, Klebsiella was the most significant microorganism, followed by Escherichia coli and Pseudomonas aeruginosa.

scholarly journals Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19

2020 ◽  
Author(s):  
Peggy Perrin ◽  
Nicolas Collongues ◽  
Seyyid Baloglu ◽  
Dimitri Bedo ◽  
Xavier Bassand ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Clinical Laboratory ◽  
Severe Disease ◽  
Brain Mri ◽  
Case Series ◽  
Neurological Manifestations ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Mri Findings ◽  
Depth Analysis

Severe disease and uremia are risk factors for neurological complications of coronavirus disease-2019 (COVID-19). An in-depth analysis of a case series was conducted to describe the neurological manifestations of patients with COVID-19 and gain pathophysiological insights that may guide clinical decision-making – especially with respect to the cytokine release syndrome (CRS). Extensive clinical, laboratory, and imaging phenotyping was performed in five patients. Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Neurological disturbances were remarkably accompanied by laboratory evidence of CRS. SARS-CoV-2 was undetectable in the cerebrospinal fluid. Hyperalbuminorachy and increased levels of the astroglial protein S100B were suggestive of blood-brain barrier (BBB) dysfunction. Brain MRI findings comprised evidence of acute leukoencephalitis (n = 3, of whom one with a hemorrhagic form), cytotoxic edema mimicking ischemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted – resulting in rapid recovery from neurological disturbances in two cases. Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory, and imaging similarities with those of chimeric antigen receptor-T cell-related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.

Malignant otitis externa: case series

2010 ◽  
Vol 124 (8) ◽  
pp. 846-851 ◽  
Author(s):  
T Ali ◽  
K Meade ◽  
S Anari ◽  
M R ElBadawey ◽  
I Zammit-Maempel
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Case Series ◽  
Case Review ◽  
Retrospective Case ◽  
North East ◽  
Malignant Otitis Externa

AbstractBackground:In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population.Method:Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009.Results:Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases.Conclusions:The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

scholarly journals A.05 An epidemiologic study of SLC52A2-related Riboflavin Transport Deficiency

2017 ◽  
Vol 44 (S2) ◽  
pp. S9-S10
Author(s):  
JK Mah ◽  
M Menezes ◽  
K Massey
Keyword(s):  
Neurodegenerative Disorder ◽  
Early Recognition ◽  
Epidemiologic Study ◽  
Case Series ◽  
High Dose ◽  
Case Review ◽  
Retrospective Case ◽  
Limb Weakness ◽  
Presenting Symptoms ◽  
Transporter Deficiency

Background: Riboflavin transporter deficiency (RTD), formerly known as Brown-Vialetto-van Laere syndrome, is an early-onset neurodegenerative disorder with distinctive phenotypes. RTD is caused by mutations in either the SLC52A2 or SLC52A3 genes that encode riboflavin transporters RFVT-2 and RFVT-3, respectively. Methods: This was a 3-year retrospective case review from the Cure RTD International Registry. Results: 73 individuals (~60% female, 14 deceased) from 56 families had genetically confirmed RTD Type 2, including 30 novel SLC52A2 mutations (24 missense, 2 nonsense, 4 deletion). The mean ages at symptom onset and at diagnosis were 2.4 years (SD 1.5, range 0.25–8, n=63) and 12.0 years (SD 10.2, range 0.75–52, n=56) respectively. Most common presenting symptoms were sensory ataxia (n=43), sensorineural hearing loss (n=22), nystagmus/visual loss secondary to optic atrophy (n=14), upper limb weakness (n=11), and respiratory insufficiency (n=9). Treatment included high dose riboflavin, other supplements, and supportive care; 7 individuals required transfusions for anemia pre-riboflavin treatment and 17 (25%) received a cochlear implant. The minimum prevalence of RTD was estimated to be 1 per million, with >100 new cases each year. Conclusions: This is the largest case series of RTD to date. Early recognition and prompt riboflavin treatment is essential for survival and optimal outcome.

scholarly journals Beware of the Migrating Chest Pain and Widened Mediastinum: Case Series on Aortic Dissection

2002 ◽  
Vol 9 (2) ◽  
pp. 95-101
Author(s):  
CH Chung ◽  
KK Lai
Keyword(s):  
Pericardial Effusion ◽  
Aortic Dissection ◽  
Case Series ◽  
District General Hospital ◽  
X Rays ◽  
Case Review ◽  
Retrospective Case ◽  
Superior Mediastinum ◽  
Presenting Symptoms ◽  
Life Threatening

Objective Aortic dissection is not a rare life-threatening emergency. Undiagnosed and untreated aortic dissection is associated with a high mortality. A review of cases in the hospital may provide a baseline picture to guide clinical decisions. Design Retrospective case review for a period of 3 years and 4 months. Setting District general hospital near the Hong Kong – Shenzhen ‘border’ with 24-hour Accident & Emergency service but without cardiothoracic surgical capability. Population All cases coded as ‘aortic dissection’ in the computerized ‘Clinical Management System’ of the hospital. Main outcome measures Date, sex, age, history of hypertension, presenting symptoms, pulse deficit, chest X-ray findings, pericardial effusion, A&E diagnosis, type of dissection and patient outcome. Results From August 1998 to November 2001, 26 cases of aortic dissection were identified. There were 19 males and 7 females. Age range was 26 to 90 years (mean 65.04 ± SD 15.04, median 66.50, mode 65). In the plain chest X-rays, widened superior mediastinum (>8 cm) was present in 19 patients (73.1%) and pleural effusion in three (11.5%). Pericardial effusion was found in six patients (23.1%). As regard to outcome, 11 were discharged home (42.3%), 14 were transferred to cardiothoracic surgical unit (where two subsequently died) and one died in the hospital. Conclusion The prevalence of aortic dissection may be more common than is generally appreciated by emergency physicians. Owing to its variable clinical presentations mimicking other diseases, the diagnosis of aortic dissection is easily missed. Higher clinical vigilance should be exercised for this potentially deadly condition.

scholarly journals Interferon Alpha Association with Neuromyelitis Optica

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Nasrin Asgari ◽  
Anne Voss ◽  
Troels Steenstrup ◽  
Kirsten Ohm Kyvik ◽  
Egon Stenager ◽  
...  
Keyword(s):  
Disease Activity ◽  
Interferon Alpha ◽  
Neuromyelitis Optica ◽  
Inflammatory Diseases ◽  
Case Series ◽  
Population Based ◽  
Mri Findings ◽  
Retrospective Case ◽  
Negative Effect ◽  
Clinical Consequences

Interferon-alpha (IFN-α) has immunoregulatory functions in autoimmune inflammatory diseases. The goal of this study was to determine occurrence and clinical consequences of IFN-αin neuromyelitis optica (NMO) patients. Thirty-six NMO and 41 multiple sclerosis (MS) patients from a population-based retrospective case series were included. Expanded Disability Status Scale (EDSS) score and MRI findings determined disease activity. Linear regression was used to assess the effects of the level of IFN-αon disability (EDSS). IFN-αwas determined by sensitive ELISA assays. IFN-αwas detectable in sera from 9/36 NMO patients, significantly more often than in the MS group (2/41) (P=0.0197). A higher frequency of IFN-αwas observed in NMO patients with acute relapse compared to NMO patients in remission (P<0.001) and compared to the MS patients with relapse (P=0.010). In NMO patients, the levels of IFN-αwere significantly associated with EDSS (P=0.0062). It may be concluded that IFN-αwas detectable in a subgroup of NMO patients. Association of IFN-αlevels with clinical disease activity and severity suggests a role for IFN-αin disease perpetuation and may provide a plausible explanation for a negative effect of IFN-1 treatment in NMO patients.

scholarly journals Prevalence of cranial MRI findings in girls with central precocious puberty: a systematic review and meta-analysis

2018 ◽  
Vol 31 (7) ◽  
pp. 701-710 ◽  
Author(s):  
Sena Cantas-Orsdemir ◽  
Jane L. Garb ◽  
Holley F. Allen
Keyword(s):  
Random Effects ◽  
Precocious Puberty ◽  
Case Reports ◽  
Case Series ◽  
Central Precocious Puberty ◽  
Significant Heterogeneity ◽  
Random Effects Model ◽  
Age Group ◽  
Mri Findings ◽  
Pooled Prevalence

Abstract Background Some pediatric endocrinologists recommend that girls with central precocious puberty (CPP) have cranial magnetic resonance imaging (MRI) performed only if they are younger than 6 years of age. However, no practice guidelines exist. The objective of this review was to assess the frequency of intracranial lesions in girls with CPP. Content We searched six electronic databases (PubMed, Cochrane, Web of Science, SCOPUS, ProQuest, and Dissertation & Theses) from 1990 through December 2015. We included studies on girls with CPP and MRI data. Case reports, case series, studies from the same author/group with the same patient population, and studies with conditions predisposing to CPP were excluded. Two physicians independently reviewed the search results and extracted data. A random-effects model was used to obtain pooled prevalence of positive MRI’s across studies. Heterogeneity among studies was evaluated with the Q-statistic. Publication bias was assessed with funnel plots and Egger’s test. Pooled prevalence was computed by age group. A linear regression assessed the relationship between intracranial lesion prevalence and healthcare availability. We included 15 studies with a total of 1853 girls <8 year old evaluated for CPP. Summary The pooled prevalence from all studies was 0.09 [95% confidence interval (CI) 0.06–0.12]. There was a significant heterogeneity, indicating the appropriateness of a random effects model in computing pooled prevalence. In the few studies stratified by age group, pooled prevalence was 25% in girls <6 years vs. 3% in girls 6–8 of age. Outlook Our results support that the benefit of routine MRIs in girls with CPP older than 6 years of age without any neurological concerns is not clear-cut.

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