scholarly journals The almost-invisible perineurioma

2015 ◽  
Vol 39 (3) ◽  
pp. E13 ◽  
Author(s):  
Carlos E. Restrepo ◽  
Kimberly K. Amrami ◽  
Benjamin M. Howe ◽  
P. James B. Dyck ◽  
Michelle L. Mauermann ◽  
...  
Keyword(s):  
Rare Condition ◽  
Nerve Fibers ◽  
Clinical Suspicion ◽  
Large Field ◽  
Slice Thickness ◽  
Conventional Mri ◽  
Electrophysiological Studies ◽  
Intraneural Perineurioma ◽  
Slow Growing ◽  
Perineurial Cells

Intraneural perineurioma is a rare, benign slow-growing lesion arising from the perineurial cells that surrounds the peripheral nerve fibers. Typically it presents during childhood and young adulthood as a motor mononeuropathy. MRI plays an essential role in the diagnosis and localization of the lesion, which appears as a fusiform enlargement of the nerve fascicles that enhances intensely with gadolinium. Despite the typical clinical and radiological features, intraneural perineurioma remains largely underdiagnosed because of the lack of familiarity with this entity, but also as a result of technical limitations with conventional MRI that is typically performed as a screening test over a large field of view and without contrast sequences. The purpose of this article is to present the pitfalls and pearls learned from years of experience in the diagnosis and management of this relatively rare condition. Clinical suspicion and detailed neurological examination followed by high-quality electrophysiological studies (EPS) must lead to an adequate preimaging localization of the lesion and narrowing of the imaging area. The use of high-resolution (3-T) MRI combined with gadolinium administration will allow adequate visualization of the internal anatomy of the nerve and help in differentiating other causes of neuropathy. In cases where the lesion is not recognized but clinical suspicion is high, possible errors must be assessed, including the EPS localization, area of imaging, MRI resolution, and slice thickness.

Platypnoea-orthodeoxia syndrome: the importance of the patient’s posture for diagnosis

2021 ◽  
Vol 14 (6) ◽  
pp. e243210
Author(s):  
Carla Pereira Fontes ◽  
Samuel Barbosa Fonseca ◽  
Mário Santos
Keyword(s):  
Transthoracic Echocardiography ◽  
Rare Condition ◽  
Definitive Diagnosis ◽  
Clinical Suspicion ◽  
Oxygen Desaturation ◽  
Arterial Oxygen ◽  
Common Cause ◽  
Intracardiac Shunt ◽  
High Clinical Suspicion ◽  
Functional Components

Platypnoea-orthodeoxia syndrome (POS) is a rare condition characterised by the association of dyspnoea and arterial oxygen desaturation induced by standing and relieved by recumbency. The precise mechanism remains poorly understood, but it appears to involve both anatomical and functional components producing a significant right-to-left shunting under certain postural conditions. This syndrome is associated with either intracardiac or extracardiac aetiologies, and the diagnosis depends on high clinical suspicion. Intracardiac shunt is the most common cause of POS and can be identified through echocardiography with bubble study. We report the case of a patient with POS secondary to a paradoxical shunt through the patent foramen oval, whose definitive diagnosis was only possible with contrasted transthoracic echocardiography in the sitting and standing positions.

scholarly journals The steps until surgery in the management of Baastrup’s Disease (kissing spine syndrome)

2019 ◽  
Vol 2019 (6) ◽  
Author(s):  
Axel Kerroum ◽  
Pietro Aniello Laudato ◽  
Marc R Suter
Keyword(s):  
Vertebral Column ◽  
Rare Condition ◽  
Clinical Suspicion ◽  
Low Back ◽  
Imaging Studies ◽  
Close Approximation ◽  
Radiological Findings ◽  
Spinous Processes ◽  
Baastrup’S Disease ◽  
Detailed Imaging

Abstract Baastrup’s disease is a rare condition of the vertebral column often misdiagnosed and wrongly treated due to poor knowledge, characterized by low back pain arising from the close approximation of adjacent posterior spinous processes and resultant degenerative changes. Diagnosis rests on clinical examination and detailed imaging studies. Proposed therapies include conservative treatment, percutaneous infiltrations or surgical therapies. We present the case of a 31-year-old man with persistent chronic lumbago for several years. In whom, the diagnosis of Baastrup’s disease was high suspected clinically, with a final surgical treatment despite the absence of inflammation on imaging studies, which allowed the diagnostic confirmation and the return to a normal social and professional life. We wish through this case, to expose the different steps of interventional diagnostic/therapeutical procedures until the surgical management in a clinical suspicion of Baastrup’s diseases with unclear radiological findings.

Arachnoid Cyst Confined to the Internal Auditory Canal—Endoscope-Assisted Resection: Case Report and Review of the Literature

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. E267-E270 ◽  
Author(s):  
Steffen Kristian. Fleck ◽  
Jörg. Baldauf ◽  
Soenke. Langner ◽  
Silke. Vogelgesang ◽  
Henry Werner. Siegfried Schroeder
Keyword(s):  
Arachnoid Cyst ◽  
Cyst Wall ◽  
Internal Auditory Canal ◽  
Rare Condition ◽  
Nerve Fibers ◽  
Neurological Deficits ◽  
Microsurgical Technique ◽  
Endoscopic Assistance ◽  
Microsurgical Resection ◽  
Neurovascular Structures

abstract BACKGROUND AND IMPORTANCE: An arachnoid cyst confined to the internal auditory canal is a rare condition. Different pathogeneses are discussed, and a progressive enlargement of the cysts has been reported. This case illustrates the beneficial aspect of endoscopic assistance in microsurgical resection of this lesion. CLINICAL PRESENTATION: A slowly progressive hearing loss developed in a 35-year-old woman over 2 years; she reported experiencing tinnitus for 7 years. Magnetic resonance imaging revealed a cystic lesion in the internal auditory canal appearing hypointense on T1-weighted images and hyperintense on T2-weighted images, suggesting an arachnoid cyst. INTERVENTION: The cyst wall was fenestrated and partially resected in an endoscope-assisted microsurgical technique. Adherent vestibular nerve fibers in the cyst wall prevented total removal of the cyst. The histological examination confirmed the diagnosis of an arachnoid cyst. CONCLUSION: The endoscope-assisted microsurgical technique enables a safe cyst resection with good visualization of important neurovascular structures within the internal auditory canal. Small remnants of the capsule that are firmly attached to important neurovascular structures should be left in place rather than risk neurological deficits.

scholarly journals Surgical treatment of lumbar canal stenosis with concomitant aggressive vertebral haemangioma

2020 ◽  
Vol 6 (4) ◽  
pp. 860
Author(s):  
Ankur D. Kariya ◽  
Pramod A. Jain ◽  
Kisan R. Patond
Keyword(s):  
Spinal Canal ◽  
Vascular Malformations ◽  
Rare Condition ◽  
Cord Compression ◽  
Spinal Canal Stenosis ◽  
Vertebral Hemangioma ◽  
Canal Stenosis ◽  
The Common ◽  
Vertebral Hemangiomas ◽  
Slow Growing

<p>Vertebral hemangiomas are the most common benign spinal tumours which are asymptomatic, slow-growing benign vascular malformations. They usually involve the vertebral body. However, the involvement of the posterior elements may present with spinal cord compression. Vertebral hemangiomas exist as a continuum of manifestations and lesions ranging from the common asymptomatic forms to rare compressive lesions. Presence of multilevel spinal canal stenosis along with an atypical vertebral hemangioma with cord is a rare condition and represents a treatment challenge. We report a case of spinal canal stenosis at L2 to L4 spinal levels along with an atypical vertebral hemangioma at L3 vertebra with extension to bilateral pedicles. This tumour caused neurological manifestations and was surgically treated with posterior decompression and stabilization with transpedicular screws and rods along with vertebroplasty for the hemangioma. Presence of an atypical hemangioma with co-existing spinal canal stenosis is a rare indication of spinal fusion. Vertebroplasty for the treatment of hemangioma in such cases is imperative.</p>

scholarly journals Mesothelioma with Nonbacterial Thrombotic Endocarditis: A Case Report

2021 ◽  
Vol 59 (243) ◽  
pp. 1170-1173
Author(s):  
Avatar Verma ◽  
Narendra Bhatta ◽  
Deebya Raj Mishra ◽  
Achyut Bhakta Acharya ◽  
Rejina Shahi ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiac Failure ◽  
Disseminated Intravascular Coagulation ◽  
Malignant Neoplasm ◽  
Rare Condition ◽  
Clinical Suspicion ◽  
Pleural Mesothelioma ◽  
Rare Association ◽  
Autoimmune Conditions ◽  
Nonbacterial Thrombotic Endocarditis

Non-bacterial thrombotic endocarditis is a rare condition characterized by noninfectious vegetation on cardiac valves which are often associated with malignancy. It often presents with features of embolism rather than cardiac failure. These are usually seen in autoimmune conditions, disseminated intravascular coagulation, malignancy of gut and lung but has also been reported in other malignancies as well. This entity is rare but one must have a clinical suspicion of the disease especially in a patient suffering from malignancy presenting with the embolic phenomenon. In this report, we are presenting a case of non-bacterial thrombotic endocarditis in an inpatient with pleural mesothelioma, a rare malignant neoplasm arising from pleura in a 35 years old mason, and a rare association as well.

Nivolumab induced hypophysitis in an advanced RCC patient

2022 ◽  
pp. 107815522110722
Author(s):  
Merve Korkmaz Yilmaz ◽  
Ilkay Gulturk ◽  
Seher Yildiz Tacar ◽  
Mesut Yilmaz
Keyword(s):  
Renal Cell Carcinoma ◽  
Case Report ◽  
Immune Checkpoint Inhibitors ◽  
Checkpoint Inhibitors ◽  
Rare Condition ◽  
Oral Route ◽  
Clinical Suspicion ◽  
High Dose ◽  
Hormonal Profile ◽  
High Degree

Introduction: Immune checkpoint inhibitors (ICIs) are being commonly used to treat solid tumours such as renal cell carcinoma. Hypophysitis is an acute or chronic inflammation of the pituitary gland and nivolumab or pembrolizumab induced hypophysitis is markedly lower compared to ipilimumab. Case report: We present a novel case of a patient with mRCC who was diagnosed with nivolumab induced hypophysitis based on clinical suspicion due to his hormonal profile and a range of symptoms that he developed during nivolumab immunotherapy. Management and outcome: He was treated with high dose of hydrocortisone administered intravenously, subsequently changed to the oral route and physiologic dose. Discussion: Nivolumab induced hypophysitis is a rare condition that usually presents with fewer symptoms. High degree of clinical suspicion and a multidisciplinary team required to diagnose and treat such cases.

scholarly journals Convulsive Seizures as Presenting Symptom of Metronidazole-Induced Encephalopathy: A Case Report

2018 ◽  
Vol 10 (1) ◽  
pp. 34-37 ◽  
Author(s):  
Caspar Godthaab Sørensen ◽  
William Kristian Karlsson ◽  
Faisal Mohammad Amin ◽  
Mette Lindelof
Keyword(s):  
Case Report ◽  
Rare Condition ◽  
Pleural Empyema ◽  
Clinical Suspicion ◽  
Cerebellar Dysfunction ◽  
Blood Samples ◽  
Hyperintense Signal ◽  
Signal Changes ◽  
Convulsive Seizures

Introduction: Encephalopathy and convulsive seizures are rare manifestations of metronidazole toxicity. The incidence is unknown, but the condition has most frequently been reported in patients in their fifth to sixth decades. Usually, this condition is regarded as reversible, but permanent deficits and even death have been reported. Case Report: A 66-year-old female patient undergoing metronidazole treatment for pleural empyema was admitted to our institution after her second episode of seizure. Over the course of 1 week after admittance, the patient developed several convulsive seizures along with progressive cerebellar dysfunction and cognitive impairment. MRI revealed bilateral, symmetrical hyperintense signal changes in the pons and dentate nuclei. EEG, ECG, lumbar puncture, and blood samples were normal. The patient improved already 2–3 days after discontinuation of metronidazole and was discharged fully recovered after 17 days. Follow-up clinical assessment and MRI were unremarkable. Conclusion: Metronidazole-induced encephalopathy is a rare condition, and due to a general lack of awareness the diagnosis is often delayed. This condition should be considered in metronidazole-treated patients presenting with unprovoked seizures, myoclonus, cerebellar signs, and encephalopathy. Characteristic MRI lesions may support the clinical suspicion.

Principles of skin malignancies management

2018 ◽  
pp. 543-548
Author(s):  
Abdullah Jibawi ◽  
Mohamed Baguneid ◽  
Arnab Bhowmick
Keyword(s):  
Risk Factors ◽  
Local Therapy ◽  
Squamous Cell Carcinomas ◽  
Clinical Suspicion ◽  
Age Group ◽  
Skin Tumours ◽  
Basal Cell Carcinomas ◽  
Treatment Plans ◽  
The Uk ◽  
Slow Growing

Melanoma is the second most common cancer in the age group 15–34: more than two young adults in the UK are diagnosed with melanoma every day. Cutaneous squamous cell carcinomas (SCCs) are common, arise from the keratinizing cells of the epidermis or its appendages, and have a curative rate following local therapy of >90%. Basal cell carcinomas (BCC) are slow-growing, locally invasive malignant epidermal skin tumours, predominantly affecting Caucasians. Clinical suspicion should always arise where risk factors and clinical behaviour of a skin lesion exist (abnormal change in colour, size, or shape for example). Excisional biopsies are usually required. Staging and further treatment plans should follow accepted protocols.

scholarly journals Multiple Perineuriomas in Chicken (Gallus gallus domesticus)

2005 ◽  
Vol 42 (2) ◽  
pp. 176-183 ◽  
Author(s):  
T. Toyoda ◽  
K. Ochiai ◽  
K. Ohashi ◽  
Y. Tomioka ◽  
T. Kimura ◽  
...  
Keyword(s):  
Rare Condition ◽  
Gallus Gallus ◽  
Gallus Domesticus ◽  
Gallus Gallus Domesticus ◽  
Specific Sequence ◽  
Spindle Cells ◽  
Specific Pathogen ◽  
Intraneural Perineurioma ◽  
Pinocytotic Vesicles ◽  
Plexus Brachial

Intraneural perineurioma is an extremely rare condition characterized by perineurial cell proliferation within peripheral nerve (PN) sheaths. In the veterinary field, this entity has been reported only in a dog. We examined multiple enlargements of PNs in 11 chickens ( Gallus gallus domesticus) (9 Japanese bantams and 2 specific pathogen-free White Leghorn), which were inoculated with an avian leukosis virus (ALV) causing so-called fowl glioma. All chickens clinically exhibited progressive leg paralysis. Lumbosacral plexus, brachial plexus, and/or spinal ganglion were commonly affected, and these nerves contained a diffuse proliferation of spindle cells arranged concentrically in characteristic onion bulb-like structures surrounded by residual axons and myelin sheaths. The spindle cells were immunohistochemically negative for S-100α/β protein. Electron microscopy revealed that these cells were characterized by short bipolar cytoplasmic processes, occasional cytoplasmic pinocytotic vesicles, and discontinuous basal laminae. These features are consistent with those of intraneural perineurioma. Furthermore, the specific sequence of the ALV was detected in the PN lesions of 8/11 (73%) birds by polymerase chain reaction. These results indicate that the multiple intraneural perineuriomas of chicken may be associated with the ALV-A causing fowl glioma.

Determination of optimum pixel size and slice thickness for tractography and ulnar nerve diffusion tensor imaging at the cubital tunnel using 3T MRI

2020 ◽  
pp. 028418512095196
Author(s):  
Sun-Young Park ◽  
Sung Hye Koh ◽  
In Jae Lee ◽  
Kwanseop Lee ◽  
Yul Lee
Keyword(s):  
Diffusion Tensor Imaging ◽  
Ulnar Nerve ◽  
Diffusion Tensor ◽  
Nerve Fibers ◽  
Cubital Tunnel ◽  
Slice Thickness ◽  
Fiber Tractography ◽  
Pixel Size ◽  
Cross Sectional ◽  
Visual Score

Background Small peripheral nerve tractography is challenging because of the trade-off among resolution, image acquisition time, and signal-to-noise ratio. Purpose To optimize pixel size and slice thickness parameters for fiber tractography and diffusion tensor imaging (DTI) of the ulnar nerve at the cubital tunnel using 3T magnetic resonance imaging (MRI). Material and Methods Fifteen healthy volunteers (mean age 30 ± 6.8 years) were recruited prospectively. Axial T2-weighted and DTI scans were acquired, covering the cubital tunnel, using different pixel sizes and slice thicknesses. Three-dimensional (3D) nerve tractography was evaluated for the median number and length of the reconstructed fiber tracts and visual score from 0 to 5. Two-dimensional (2D) cross-sectional DTI was evaluated for fractional anisotropy (FA) values throughout the length of the ulnar nerve. Results A pixel size of 1.3 mm2 revealed the highest number of reconstructed nerve fibers compared to that of 1.1 mm2 ( P = 0.048), with a good visual score. A slice thickness of 4 mm had the highest number of reconstructed nerve fibers and visual score compared with other thicknesses (all P < 0.05). In 2D cross-sectional images, the median FA values were in the range of 0.40–0.63 at the proximal, central, and distal portions of the cubital tunnel. Inter-observer agreement for all parameters was good to excellent. Conclusion For fiber tractography and DTI of the ulnar nerve at the cubital tunnel, optimal image quality was obtained using a 1.3-mm2 pixel size and 4-mm slice thickness under MR parameters of this study at 3T.

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