scholarly journals Cerebellar Infarct Accompanied by Acute Hydrocephalus: A Case Report of 1-Year Follow-up in Rural Neurosurgical Practice

2021 ◽  
Vol 9 (C) ◽  
pp. 280-285
Author(s):  
Reza Akbar Bastian ◽  
Rachmat Andi Hartanto ◽  
Rohmania Setiarini
Keyword(s):  
Ct Scan ◽  
Rural Areas ◽  
Signs And Symptoms ◽  
Acute Hydrocephalus ◽  
Standard Management ◽  
Threatening Condition ◽  
Life Threatening ◽  
Contrast Ct ◽  
Cerebellar Infarct

Cerebellar infarctions account for about 2-3% of all ischemic strokes, and acute hydrocephalus due to brainstem compression or compression of the cerebrospinal fluid (CSF) flows is a rare manifestation from a stroke of the posterior circulation. The condition is considered one of the most life-threatening complications in cerebellar infarct due to the possibility of transforaminal and upward transtentorial herniation. The management of patients with cerebellar infarct is challenging, because the patient usually presents with non-specific signs and symptoms until the patient loses consciousness. Standard management should be provided by a stroke unit team or neuro-intensive care unit. The precision timing of treatment and evaluation with close observation is crucial, even when there is no life-threatening condition at initial presentation, but sometimes it is difficult to fulfill in rural areas due to the substandard facilities and lack of resources. Here we report a case of cerebellar infarct with massive edema in association with acute hydrocephalus with the progressive deterioration that happened in a rural area. A 59-year-old male patient complained about an episode of sudden headache which was followed by dizziness, vomiting, and loss of balance. A head non-contrast CT scan in the emergency room (ER) is performed 4 hours after ictus, showed a slightly hypodense lesion in the left cerebellum, without accompanying edema and hydrocephalus. The patient was then managed conservatively in the ward. In the next 36 hours, his consciousness level was reduced and a head CT scan evaluation showed the development of massive edema of cerebellar infarct with acute hydrocephalus. The patient underwent an emergency surgical procedure with suboccipital decompressive craniectomy (SDC) with strokectomy, expanded duraplasty, and ventricular drainage (ventriculoperitoneal shunt). Satisfactory results with rapid resolution of GCS was seen at daily follow-up after surgery. A 1-year follow-up also showed remarkable outcomes.

Ultrasound diagnosis of dissecting thoracic aortic aneurysms: procedure with a handheld device and a video-illustrated case

2021 ◽  
Vol 51 (1) ◽  
pp. 10-15
Author(s):  
Kenneth V Iserson ◽  
Sri Devi Jagjit ◽  
Balram Doodnauth
Keyword(s):  
Aortic Dissection ◽  
Correct Diagnosis ◽  
Signs And Symptoms ◽  
Aortic Aneurysms ◽  
Thoracic Aortic Aneurysms ◽  
Handheld Device ◽  
Thoracic Aortic Dissection ◽  
Threatening Condition ◽  
Life Threatening ◽  
Handheld Ultrasound

Acute thoracic aortic dissection is an uncommon, although not rare, life-threatening condition. With protean signs and symptoms that often suggest more common cardiac or pulmonary conditions, it can be difficult to diagnose. Ultrasound has proven useful in making the correct diagnosis. This case demonstrates that training gained using standard ultrasound machines can be easily and successfully adapted to newer handheld ultrasound devices. The examination technique using the handheld device is illustrated with photos and a video.

scholarly journals A rare case of fat embolism syndrome secondary to abdominal liposuction and gluteal fat infiltration

2020 ◽  
Vol 2020 (12) ◽  
Author(s):  
Salvador Recinos ◽  
Sabrina Barillas ◽  
Alejandra Rodas ◽  
Javier Ardebol
Keyword(s):  
Right Ventricular Dysfunction ◽  
Signs And Symptoms ◽  
Fat Embolism ◽  
Fat Infiltration ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Bone Marrow Harvesting ◽  
Dermatologic Manifestations

Abstract Fat embolism syndrome (FES) is a rare, life-threatening condition habitually associated with traumatic events such as fractures and, less commonly, burns, liposuction and bone marrow harvesting and transplant [ 1]. The biochemical theory for this condition suggests that fat droplets embolize and convert into fatty acids, eventually leading to toxic injury and inflammation, which results in increased vascular permeability, edema and hemorrhage [ 2]. FES may have an asymptomatic interval lasting 12–72 hours after the insult; however, in some cases, signs have also been seen intraoperatively. Pulmonary signs and symptoms are customarily the earliest and manifest in 75% of patients. Nevertheless, neurologic and dermatologic manifestations are also characteristic, and most severe cases could perhaps present with disseminated intravascular coagulation, right ventricular dysfunction, shock or death. The following case consists of a 37-year-old patient that presented with fat embolism syndrome during liposuction and gluteal fat infiltration.

scholarly journals Endoscopic follow-up of cyanoacrylate obliteration of gastric varices

2009 ◽  
Vol 46 (1) ◽  
pp. 81-84 ◽  
Author(s):  
Fernanda Prata Martins ◽  
Erika Pereira de Macedo ◽  
Gustavo Andrade de Paulo ◽  
Frank Shigueo Nakao ◽  
José Celso Ardengh ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Portal Hypertension ◽  
Gastric Varices ◽  
Study Endpoint ◽  
Mild Abdominal Pain ◽  
Threatening Condition ◽  
Life Threatening ◽  
Related Mortality ◽  
Overall Mortality

Bleeding from gastric varices is a life-threatening condition. We report our experience with cyanoacrylate injection. Twenty three patients with portal hypertension and gastric varices underwent intra-variceal injection of a cyanoacrylate/lipiodol solution (1:1). Study endpoint was variceal obliteration. Mean follow-up was 25.3 months. Variceal obliteration was achieved in 87% of patients. Recurrence occurred in one patient (4.3%) and rebleeding in another case (4.3%). Mild abdominal pain was described in 13% of patients. Overall mortality was 21.7% and rebleeding related mortality rate was 4.3%. Our results confirm that cyanoacrylate injection is effective and safe to eradicate gastric varices.

scholarly journals Successful treatment of pulmonary mucormycosis caused by Rhizopus microsporus with posaconazole

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
F. Yuan ◽  
J. Chen ◽  
F. Liu ◽  
Y. C. Dang ◽  
Q. T. Kong ◽  
...  
Keyword(s):  
Fungal Culture ◽  
Rhizopus Microsporus ◽  
Pulmonary Tissue ◽  
Case Presentation ◽  
Common Cause ◽  
Pulmonary Mucormycosis ◽  
Threatening Condition ◽  
Life Threatening ◽  
One Year

Abstract Background Mucormycosis is a rare fungal infection occurring chiefly in the lung or the rhino-orbital-cerebral compartment, particularly in patients with immunodeficiency or diabetes mellitus. Among Mucorales fungi, Rhizopus spp. are the most common cause of mucormycosis. Case presentation We report a case of pulmonary mucormycosis caused by Rhizopus microsporus in a young patient with diabetes but no other apparent risk factors. The diagnosis mainly relied on clinical manifestation, positive pulmonary tissue biopsy, and fungal culture. The patient was successfully treated with posaconazole oral suspension and remains asymptomatic at one-year follow-up. Conclusions Pulmonary mucormycosis is a life-threatening condition and posaconazole is an effective treatment for pulmonary mucormycosis caused by Rhizopus microspores.

Abstract P147: Association Of Rosuvastatin Use With Risk Of Rhabdomyolysis Across Chronic Kidney Disease Status

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Jung-Im Shin ◽  
Yao Qiao ◽  
Aditya Surapaneni ◽  
Lesley Inker ◽  
Derek Fine ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Proportional Hazards ◽  
Disease Status ◽  
Cox Proportional Hazards ◽  
Lower Egfr ◽  
Threatening Condition ◽  
Life Threatening ◽  
End Stage

Introduction: Statin-induced rhabdomyolysis is a rare, but potentially life-threatening condition. It is unknown whether specific statins carry a greater risk of rhabdomyolysis and whether the risk differs between patients with and without chronic kidney disease (CKD). The objective of this study was to investigate the association of rosuvastatin use vs. atorvastatin use with the risk of rhabdomyolysis across CKD status. Hypothesis: Rosuvastatin use is associated with a higher risk of rhabdomyolysis as compared to atorvastatin use and the risk is greater among those with CKD than those without CKD. Methods: We identified adult patients who initiated rosuvastatin or atorvastatin between January 1, 2004 and December 31, 2018 and were free of end-stage kidney disease at the time of prescription in the Geisinger Health System. The association between rosuvastatin use and rhabdomyolysis was assessed using Cox proportional hazards regression models with an interaction between rosuvastatin use and CKD (i.e., estimated glomerular filtration rate <60 ml/min/1.73 m 2 ) in an inverse probability of treatment weighted (IPTW) sample. Results: Of 8,748 rosuvastatin users (mean [SD] age, 59.7 [12.6] years; 49.8% female; 11.8% CKD) and 31,770 atorvastatin users (mean [SD] age, 59.1 [12.6] years; 48.2% female; 11.9% CKD), 0.7% and 0.4% patients developed rhabdomyolysis, respectively, during a median follow-up of 5.1 years. Rosuvastatin use was associated with a higher risk of rhabdomyolysis in patients with CKD (hazard ratio [HR], 3.29; 95% CI, 1.53-7.09), but not in those without CKD (HR, 1.29; 95% CI, 0.82-2.03; p-interaction=0.04). A higher risk of rhabdomyolysis associated with rosuvastatin use in lower eGFR was also observed in the analysis with continuous eGFR ( Figure ). Conclusions: The findings suggest that rosuvastatin use in patients with CKD may be associated with excess risk of rhabdomyolysis as compared to atorvastatin.

scholarly journals Tracheal development after left pulmonary artery reimplantation: an individual study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Xiaoyang Hong ◽  
Ruijie Li ◽  
Zhe Zhao ◽  
Jiangheng Guan ◽  
Hui Wang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Left Pulmonary Artery ◽  
Weaning Failure ◽  
Threatening Condition ◽  
Ventilation Weaning ◽  
Life Threatening ◽  
The Mean ◽  
Tracheal Carina

Abstract Pulmonary artery sling (PA sling) often presents as a life-threatening condition requiring urgent surgical correction. We reported 32 cases of PA sling in children who were followed up postoperatively in the past 6 years. All patients with PA slings who were admitted to the hospital from January 2012 to December 2017 and underwent surgery were retrospectively analyzed. The mean age of the 32 patients at repair was 16.97 months (range, 15 days to 128 months). Six patients required ventilator assistance for respiratory failure. All children underwent left pulmonary artery (LPA) reimplantation (n = 32), and 3 patients needed reimplantation slide tracheoplasty (n = 3) due to ventilation weaning failure. Four patients died, 27 patients survived until discharge, and 18 patients were followed up. Pulmonary computed tomography imaging and echocardiography were performed in 18 patients who were followed up. After LPA reimplantation, the tracheal carina area was significantly enlarged compared to that preoperation (p = 0.0002). In this follow-up cohort study, 75% of the patients who underwent LPA reimplantation survived until discharge. The survivors had subsequently well-developed pulmonary arteries and tracheas.

scholarly journals Swallow-induced syncope in 5 patients

2017 ◽  
Vol 7 (4) ◽  
pp. 316-323 ◽  
Author(s):  
Ibrahim Aydogdu ◽  
Can Hasdemir ◽  
Ahmet Acarer ◽  
Sezin Alpaydin ◽  
Cumhur Ertekin
Keyword(s):  
Standing Position ◽  
Permanent Pacemaker ◽  
Diagnosis And Treatment ◽  
Afferent Pathways ◽  
Electrocardiographic Monitoring ◽  
Threatening Condition ◽  
Pacemaker Placement ◽  
Life Threatening

AbstractBackground:We sought to characterize a cohort of participants with swallow-induced syncope (SIS) with clinical and electrophysiologic evaluations.Methods:Using electrocardiographic monitoring and neurophysiologic methods of swallowing, we evaluated a cohort of 5 patients with SIS, 4 of whom had longitudinal follow-up.Results:We determined electrophysiologically that the duration between the onset of swallow and a bradyarrhythmia or asystole is extremely short (2–3 seconds) in SIS. Most participants with SIS do not have a neurologic or esophageal disorder. SIS can occur with different food types, in sitting or standing position, and has varying frequency in different participants. Permanent pacemaker placement is a curative measure in SIS.Conclusions:Our findings suggest that SIS is elicited by reflex afferent pathways originating in the oropharynx, rather than an esophageal origin, as previously proposed. Our longitudinally followed cohort with detailed clinical and electrophysiologic characterization should aid the clinician in the diagnosis and treatment of this potentially life-threatening condition.

scholarly journals Hemophagocytic Lymphohistiocytosis Associated With Parvovirus B19 in a Patient With Acquired Immunodeficiency Syndrome

2019 ◽  
Vol 7 ◽  
pp. 232470961988369
Author(s):  
Precious Macauley ◽  
Mohammad Abu-Hishmeh ◽  
Carissa Dumancas ◽  
Vijay Alexander-Rajan ◽  
Fernando Piedra-Chavez ◽  
...  
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Parvovirus B19 ◽  
Signs And Symptoms ◽  
High Serum ◽  
Intrathecal Methotrexate ◽  
Immunodeficiency Virus ◽  
Threatening Condition ◽  
Life Threatening ◽  
Acquired Immunodeficiency ◽  
Immunodeficiency Syndrome

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening condition characterized by widespread inflammation due to massive immune activation and cytokine release. It is of 2 types, primary or familial and secondary or acquired. Diagnosis is made by fulfilling 5 of 8 criteria as determined by the Histiocyte Society. Treatment includes etoposide, dexamethasone, with or without intrathecal methotrexate in the presence of neurologic involvement as well as treating the underlying cause in secondary HLH. We present a case of a 23-year-old female with congenital human immunodeficiency virus (HIV) infection who presents with nonspecific signs and symptoms of cough, fever, leukopenia, and anemia, and a high-serum parvovirus B19 DNA, later diagnosed with HLH and treated with etoposide and dexamethasone. She made clinical improvements and was successfully discharged to home after 26 days of admission.

scholarly journals Plasma Exchange as a Rescue Therapy for Acute Liver Failure

2021 ◽  
Author(s):  
Nupur B Patel ◽  
Anand Sharma ◽  
Itish Patnaik ◽  
Ashok Kumar
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Plasma Exchange ◽  
Resource Constraints ◽  
Rescue Therapy ◽  
Therapeutic Option ◽  
Liver Function Tests ◽  
Threatening Condition ◽  
Life Threatening

Acute Liver Failure (ALF) is a life-threatening condition and often necessitates Liver Transplantation (LT). However, LT is not available to most patients in developing countries due to resource constraints. Here, authors presents a case of 30-year-old female with ALF and fulfilled the criteria for LT. The aetiology of ALF could not be diagnosed in her. Due to the lack of LT facilities, she was offered plasma exchange as a therapeutic option, which resulted in improvement in sensorium and Liver Function Tests (LFT) {bilirubin, International Normalised Ratio (INR), Aspartate Aminotransferase (AST), Alanine Aminotransferase (ALT)} over a period of two weeks. She was discharged and was doing well during follow-up. Plasma exchange is a less studied but potential treatment option for ALF when LT is not feasible.

scholarly journals Pituitary Apoplexy: A Retrospective Study of 33 Cases From a Single Center

2021 ◽  
Vol 12 ◽  
Author(s):  
Henrik Falhammar ◽  
Sofia Tornvall ◽  
Charlotte Höybye
Keyword(s):  
Pituitary Apoplexy ◽  
Pituitary Surgery ◽  
University Hospital ◽  
Single Center ◽  
Precipitating Factors ◽  
Threatening Condition ◽  
Life Threatening ◽  
Inhomogeneous Condition ◽  
Neurosurgical Intervention

PurposeAcute symptomatic pituitary apoplexy is a rare and potentially life-threatening condition. However, pituitary apoplexy can also present with milder symptoms and stable hemodynamics. Due to the rarity of this inhomogeneous condition, clinical studies are important to increase the knowledge.MethodsWe retrospectively reviewed all consecutive cases of pituitary apoplexy being admitted between January 1st, 2005 and December 31st, 2019 at the Karolinska University Hospital, Stockholm, Sweden, for symptoms, results of magnetic resonance (MRI), biochemistry, management and mortality.ResultsThirty-three patients were identified with pituitary apoplexy, 18 were men (55%) and mean age was 46.5 (17.2) years. The incidence of symptomatic pituitary apoplexy was 1.6 patients/year (0.76 patients/1,000,000 inhabitants/year). The majority presented with headache (n=27, 82%) and hormonal deficiencies (n=18, 55%), which were most frequent in men. ACTH deficiency was present in nine patients (27% but 50% of those with hormonal deficiencies). All had the characteristic findings on MRI. Only three patients (9%) required acute pituitary surgery, while eight were operated after more than one week. Seven (21%) were on antithrombotic therapy. None of the patients died in the acute course. During follow-up (7.6 ± 4.3 years) none of the hormonal deficiencies regressed and 3 patients died from non-related causes.ConclusionOur study confirmed the rarity and the symptoms of this condition. Surprisingly, only 3 patients needed acute neurosurgical intervention, perhaps due to milder cases and a general intensified treatment of precipitating factors. An early awareness and in severe cases decision on pituitary surgery is of utmost importance to avoid severe complications.

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