scholarly journals Endonasal endoscopic transsphenoidal chiasmapexy using a clival cranial base cranioplasty for visual loss from massive empty sella following macroprolactinoma treatment with bromocriptine: case report

2016 ◽  
Vol 124 (4) ◽  
pp. 1025-1031 ◽  
Author(s):  
G. Rene Alvarez Berastegui ◽  
Shaan M. Raza ◽  
Vijay K. Anand ◽  
Theodore H. Schwartz
Keyword(s):  
Case Report ◽  
Visual Loss ◽  
Rare Event ◽  
Empty Sella ◽  
Functional Improvement ◽  
Endoscopic Endonasal ◽  
Lumbar Drainage ◽  
Visual Deterioration ◽  
Giant Prolactinoma ◽  
History Of

Visual deterioration after dopamine-agonist treatment of prolactinomas associated with empty sella syndrome and secondary optic apparatus traction is a rare event. Chiasmapexy has been described as a viable treatment option, although few cases exist in the literature. Here, a novel endonasal endoscopic approach to chiasmapexy is described and its efficacy is demonstrated in a case report. A 55-year-old female patient with a history of a giant prolactinoma and 14 years of treatment using dopaminergic agonist therapy presented to our institution with a 1-month history of visual changes. Neuroophthalmological examination confirmed severe bitemporal field defects, and MRI revealed a large empty sella with downward optic chiasmal herniation. Endoscopic endonasal chiasmapexy was performed by elevating the chiasm with lumbar drainage and filling the clival and sellar defect with an extradural liquid (HydroSet; a cranioplasty bone cement), and a piece of AlloDerm was used to cover and cushion the chiasm. Postoperative imaging demonstrated successful anatomical elevation of the optic apparatus, and the patient showed functional improvement in the visual field at 3 months postoperatively. Although rare, massive empty sellar and chiasmal descent from macroadenoma treatment can result in progressive visual loss. Here, a novel technique of endonasal endoscopic extradural cranioplasty aided by lumbar drainage is reported, which appears to be an effective technique for stabilizing and possibly reversing anatomical and visual deterioration.

scholarly journals Ovarian Torsion after Hysterectomy: Case Report and Concise Review of the Reported Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Demetrio Larraín ◽  
Andrés Casanova ◽  
Iván Rojas
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Literature Review ◽  
Rare Event ◽  
Laparoscopic Hysterectomy ◽  
Acute Onset ◽  
Ovarian Torsion ◽  
Adnexal Torsion ◽  
Concise Review ◽  
History Of

Ovarian torsion after hysterectomy is a rare event. The diagnosis of ovarian torsion is challenging because symptoms are nonspecific. We present a case of ovarian torsion 2 years after laparoscopic hysterectomy (LH). Furthermore, we performed a literature review about ovarian torsion after hysterectomy. This case shows that, in cases of acute onset pelvic pain in patients with history of hysterectomy, the adnexal torsion must be kept in mind in the differential diagnosis, especially in those women who had undergone LH.

scholarly journals Pushing behavior and hemiparesis: which is critical for functional recovery in pusher patients ? Case report

2007 ◽  
Vol 65 (2b) ◽  
pp. 536-539 ◽  
Author(s):  
Taiza E.G. Santos-Pontelli ◽  
Octávio M. Pontes-Neto ◽  
José Fernando Colafêmina ◽  
Dráulio B. de Araújo ◽  
Antônio Carlos Santos ◽  
...  
Keyword(s):  
Case Report ◽  
Barthel Index ◽  
Functional Improvement ◽  
Chronic Hypertension ◽  
Acute Hemorrhage ◽  
Lateral Posterior ◽  
History Of ◽  
Lateral Posterior Nucleus ◽  
Neuroimaging Study ◽  
The Right

We report a sequential neuroimaging study in a 48-years-old man with a history of chronic hypertension and lacunar strokes involving the ventral lateral posterior nucleus of the thalamus. The patient developed mild hemiparesis and severe contraversive pushing behavior after an acute hemorrhage affecting the right thalamus. Following standard motor physiotherapy, the pusher behavior completely resolved 3 months after the onset and, at that time, he had a Barthel Index of 85, although mild left hemiparesis was still present. This case report illustrates that pushing behavior itself may be severely incapacitating, may occur with only mild hemiparesis and affected patients may have dramatic functional improvement (Barthel Index 0 to 85) after resolution pushing behavior without recovery of hemiparesis.

scholarly journals Managing solar retinopathy with suprachoroidal triamcinolone acetonide injection in a young girl: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Ameen Marashi ◽  
Marwa Baba ◽  
Aya Zazo
Keyword(s):  
Case Report ◽  
Triamcinolone Acetonide ◽  
Young Female ◽  
Functional Improvement ◽  
Eye Drops ◽  
Suprachoroidal Space ◽  
Optical Coherence Tomography Signal ◽  
Custom Made ◽  
Snellen Chart ◽  
History Of

Abstract Background Solar retinopathy is a disease that causes photochemical toxicity in the retinal fovea tissues, leading to an acute decrease of vision. Case presentation This case report is an interventional case of an asymptomatic 17-year-old Caucasian female with a history of suddenly decreased vision due to solar retinopathy. The patient was managed with a custom-made needle injection of triamcinolone acetonide in the suprachoroidal space. Four months post suprachoroidal injection showed an anatomical and functional improvement in the ellipsoid zone layer through optical coherence tomography signal reappearance. In addition, the best-corrected visual acuity had improved from 0.1 to 1.0 on the Snellen chart with the disappearance of the scotoma. However, there was a mild increase in intraocular pressure after this procedure, controlled with topical hypertensive eye drops. Conclusion Suprachoroidal triamcinolone acetonide injection using a custom-made needle showed both functional and anatomical improvement of macular changes post-solar retinopathy, with acceptable safety outcomes in a young female.

Visual deterioration after endonasal endoscopic skull base surgery: causes, treatments, and outcomes

2021 ◽  
pp. 1-11
Author(s):  
Joseph A. Carnevale ◽  
Christopher S. Babu ◽  
Jacob L. Goldberg ◽  
Reginald Fong ◽  
Theodore H. Schwartz
Keyword(s):  
Vision Loss ◽  
Rare Event ◽  
Visual Outcome ◽  
Supplemental Oxygen ◽  
Senior Author ◽  
Endoscopic Endonasal ◽  
Blood Pressure Elevation ◽  
Visual Deterioration ◽  
Associated Risk Factors ◽  
Early Reoperation

OBJECTIVE Visual deterioration after endoscopic endonasal transsphenoidal surgery (EETS) for sellar and parasellar masses is a rare but serious complication caused by either compressive or ischemic mechanisms. Timely diagnosis and intervention may restore vision if instituted appropriately. The associated risk factors and their relation to the success of intervention are not well understood. METHODS The authors examined a series of 1200 consecutive EETS cases performed by the senior author at Weill Cornell/NewYork-Presbyterian Hospital from 2010 to 2020. Cases with postoperative visual deterioration were identified. Pre- and postoperative clinical data, mechanism of visual decline, latency to intervention, and long-term visual outcome were retrospectively collected and analyzed with appropriate statistical methods. RESULTS Twenty-one patients (1.75%) complained of early postoperative visual deterioration. The most common pathology associated with postoperative visual loss was craniopharyngioma (7.69%), followed by meningioma (5.43%) and then pituitary adenoma (1.94%). Timely intervention restored vision in 81% of patients for a 0.33% rate of permanent visual deterioration. Average time to visual deterioration was 28.8 hours, and over 70% of patients experienced vision loss within the first 13 hours. Compressive etiology (n = 11), consisting of either hematoma (n = 8) or graft displacement (n = 3), occurred 7.3 hours and 70.3 hours after surgery, respectively, and was more common in adenomas. Acute postoperative visual deterioration was more common in firm closures (4.78%) compared with soft closures (1.03%; p = 0.0006). Ischemic etiology (n = 10) occurred 10.3 hours after surgery and was more common with craniopharyngiomas and meningiomas (p = 0.08). Sixteen patients (76.2%) underwent early reoperation to explore and decompress the optic apparatus. Vision was restored to baseline after reoperation in all 11 compressive cases, whereas 6/10 ischemic cases improved with supplemental oxygen and hypervolemic hypertensive therapy (p = 0.02). Fluid expansion from 8 to 16 hours (p = 0.034) and systolic blood pressure elevation from 32 to 48 hours (p = 0.05) after surgery were significantly higher in those ischemic patients who recovered some vision compared with those with persistent visual deficits. CONCLUSIONS Visual deterioration after EETS is a rare event but can be effectively treated if acted upon appropriately and in a timely fashion. Compressive etiology is reversible with early reoperation. Ischemic etiology can be successfully treated in roughly half of cases with supplemental oxygen and hypertensive hypervolemic therapy but may result in permanent visual deterioration if not instituted appropriately or if delayed with unnecessary exploratory surgery.

Ovarian cancer associated with carcinomatous meningitis: a case report and review of the literature

2007 ◽  
Vol 17 (5) ◽  
pp. 1136-1140 ◽  
Author(s):  
L. Decelle ◽  
L. D'HONDT ◽  
M. Andre ◽  
P. Delree ◽  
B. Calicis ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cerebrospinal Fluid ◽  
Case Report ◽  
Rare Event ◽  
Carcinomatous Meningitis ◽  
Second Line ◽  
Rare Entity ◽  
Review Of The Literature ◽  
History Of ◽  
Line Chemotherapy

We report the case of a 62-year-old patient who developed a carcinomatous meningitis while on second-line chemotherapy for ovarian cancer. Cytologic analyses confirmed that carcinomatous cells of ovarian origin were present in cerebrospinal fluid. Carcinomatous meningitis is a very rare event in the natural history of ovarian carcinoma. We discuss the specificity of our case in the light of the literature. In addition, we present some relevant radiologic and pathologic documents illustrating this rare entity.

scholarly journals Upper digestive hemorrhage secondary to major duodenal papilla Dieulafoy’s lesion: Case report

2021 ◽  
Vol 10 (9) ◽  
pp. e22710918093
Author(s):  
Samuel Nuno Pereira Lima ◽  
Daniel Alves Branco Ribeiro ◽  
Luiz Paulo de Oliveira Gireli ◽  
Lauro Damasceno de Carvalho Faria ◽  
Glayson da Silveira Martins
Keyword(s):  
Acute Pancreatitis ◽  
Case Report ◽  
Gastrointestinal Bleeding ◽  
Rare Event ◽  
Clinical History ◽  
Abdominal Ultrasound ◽  
Duodenal Papilla ◽  
Dieulafoy’S Lesion ◽  
Major Duodenal Papilla ◽  
History Of

Introduction: Dieulafoy’s lesion (DL) is occasioned by a tortuous, persistent and large caliber artery that emerges the mucosa from the submucosa of an organ, eventually triggering gastrointestinal bleeding in the presence of eroding factors of the mucosa and arterial wall. The presence of DL has been described in many anatomic topographies and although it predominates in the upper digestive tract, the presence of this lesion exactly in the major duodenal papilla is a rare event. Objective: to report a case of upper gastrointestinal bleeding secondary to a major duodenal papilla DL. Case report: a 72 year-old female, admitted to hospital care with a clinical history of two months continuous, painless melena, multiple previous blood transfusions and symptomatic anemia. She was referred by another health service with the diagnostic hypothesis of hemobilia, suggested by two previous esophagogastroduodenoscopies. Her abdominal ultrasound and arteriography were normal. A third esophagogastroduodenoscopy evidenced active bleeding in the duodenal major papilla, and after a carefully analysis a papillar DL was diagnosed. It was treated by endoscopy with adrenaline 1:10000 injection and thermocoagulation. Following this procedure she evolved with severe acute pancreatitis due to papillitis and need of intensive care unit admission. No rebleeding was detected and hospitalar discharge occurred twenty days after hospitalization. Conclusion: The localization of a DL at the major papilla is a rare event and acute pancreatitis is a complication related to its endoscopic treatment.

scholarly journals Congenital vulvar teratoma: a case report

2020 ◽  
Vol 1 (1) ◽  
pp. 5-8
Author(s):  
I Nyoman Hariyasa Sanjaya ◽  
Ryan Saktika Mulyana ◽  
Evert Solomon Pangkahila ◽  
Hartanto Hartanto
Keyword(s):  
Case Report ◽  
Gestational Age ◽  
Rare Event ◽  
Body Parts ◽  
Tumor Excision ◽  
First Line Therapy ◽  
History Of ◽  
Early Tumor ◽  
Unnecessary Complication ◽  
Female Baby

Introduction: Teratoma is an embryonal neoplasm consisted of 3 germinal layers. Teratoma usually arises along the line of embryonic cleft and sinus closure formed by the fusion of skin during the embryonic development. In this case report, we present a case of fetal Teratoma on the vulval region, a very rare variant of the disease. Case: A 28-year-old woman came for a routine check-up for her first pregnancy at her 26th weeks of gestational age. On ultrasound examination, a mass was found around the fetal vulva. There was no mass or malformations on other body parts. Placenta and the amount of amniotic fluid were normal. History of congenital anomaly in the family was denied. The patient then gave birth to a female baby at 38 weeks of gestational age without any complication. The baby was healthy, 2650 gram in weight, 50 cm in length, with good APGAR Score (8-10). On the baby left labia, there was a mass measured 5 cm x 4 cm x 3 cm, with slight discoloration. We recommend an early tumor excision to prevent unnecessary complication such as malignant transformation. Although at the time of writing, the patient still waiting for the schedule to remove the tumor due to a non-medical factor. Conclusion: Congenital Teratoma in the vulvar region was a very rare event. First-line therapy is early tumor excision and usually carries an excellent prognosis.

Punctate inner choroidopathy reactivation following COVID-19: A case report

2021 ◽  
pp. 112067212110287
Author(s):  
Michele Nicolai ◽  
Maria Jolanda Carpenè ◽  
Nicola Vito Lassandro ◽  
Paolo Pelliccioni ◽  
Vittorio Pirani ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Report ◽  
Multimodal Imaging ◽  
Fundus Autofluorescence ◽  
Functional Improvement ◽  
Caucasian Woman ◽  
High Dose ◽  
Punctate Inner Choroidopathy ◽  
Corrected Visual Acuity ◽  
History Of

Purpose: The purpose of this study is to report our experience with a case of punctate inner choroidopathy (PIC) reactivation following COVID-19. Case report: A 29-year-old caucasian woman with past ophthalmological history of bilateral PIC reported sudden visual acuity decrease in her right eye (RE) 3 weeks after SARS-CoV-2 infection. Her best-corrected visual acuity (BCVA) was 20/32 in RE; fundus examination and multimodal imaging (including indocyanine-green angiography, fundus autofluorescence, and optical coherence tomography) was consistent with unilateral PIC reactivation. The active choroidal lesions responded to high-dose corticosteroids, with functional improvement. Conclusion: Sars-CoV-2 infection could induce autoimmune and autoinflammatory dysregulation in genetically predisposed subjects. We report a case of PIC reactivation following COVID-19.

scholarly journals A 17-years-old girl presenting with spontaneous cerebrospinal fluid rhinorrhea diagnosed as aqueductal stenosis: A case report

2016 ◽  
Vol 7 (2) ◽  
pp. 134
Author(s):  
Umma Salma ◽  
Mohammad Abdus Sattar Sarker ◽  
Abed Hossain Khan ◽  
Nahida Zafrin ◽  
M. A. Jalil Chowdhury
Keyword(s):  
Cerebrospinal Fluid ◽  
Differential Diagnosis ◽  
Case Report ◽  
Ventriculoperitoneal Shunt ◽  
Chronic Headache ◽  
Aqueductal Stenosis ◽  
Empty Sella ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
History Of

<p>A 17-year-old girl presented with chronic headache and spontaneous CSF rhinorrhea. She had no history of head trauma. MRI of her brain showed aqueductal stenosis associated with triventriculomegaly with partially empty sella. Following insertion of ventriculoperitoneal shunt, her headache and CSF rhinorrhea completely recovered. Though very uncommon but aqueductal stenosis should be kept as a differential diagnosis for etiology of chronic CSF rhinorrhea.</p>

scholarly journals Anton’s Syndrome in Occipital Lobe Infarction

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Khalid Mehmood ◽  
Sabeen Aftab ◽  
Nauman Ismat Butt ◽  
Fahmina Ashfaque ◽  
Aniqa Anser Khan
Keyword(s):  
Diabetes Mellitus ◽  
Case Report ◽  
Visual Loss ◽  
Occipital Lobe ◽  
Occipital Cortex ◽  
Cortical Blindness ◽  
Affected Patient ◽  
Cerebrovascular Events ◽  
Uncontrolled Diabetes ◽  
History Of

Anton's syndrome implies the situation when affected patient contradicts blindness in spite of objective documentation of loss of vision, and often confabulate to assert their bearing. It is an infrequent sequel of cortical blindness affecting both occipital cortex and other cortical centers, while patients genuinely act as if they are sighted. Our case report is of a lady, 55 years old, who presented to us with history of uncontrolled diabetes, hypertension and visual loss as a consequence of occipital lobe infarction bilaterally. In patients with evidence of occipital lobe injury and atypical visual loss, an assessment for cortical blindness and Anton's syndrome must be included. Anton's syndrome is most frequently caused by cerebrovascular disease. Any condition that causes cortical blindness may, however, lead to Anton's syndrome. Improvement in visual function after occipital lobe infarction due to cerebrovascular events is limited. Therefore, the management should be focused on rehabilitation and secondaryprevention. Keywords:  Anton’s syndrome, Occipital lobe infarct, Diabetes mellitus, Hypertension.

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