Multifocal cerebral infarction as the first manifestation of occult malignancy: Case series of trousseau's syndrome and literature review

Objective: National pathology guidelines recommend full pathologic analysis for all adult tonsillectomy specimens. We evaluated the available data on occult malignancy in adult tonsillectomy for benign indication, and created a screening system to reduce the risk of missed malignancies if routine histopathologic examination were to be discontinued. Study design: Retrospective chart review and systematic review of the literature. Setting: Tertiary care academic hospital and multi-hospital private healthcare system. Subjects and methods: A systematic literature review identified case series of adult tonsillectomy. Retrospective chart review at our institutions from 2000 to 2016 produced an additional case series. The pooled rate of occult malignancy was determined, and re-analyzed using criteria based on preoperative risk factors designed to identify patients requiring full pathologic analysis. The predicted effects of prospective application of the proposed criteria were calculated. Pooled occult malignancy prevalence was estimated. Results: Literature review and our own case series yielded 12,094 total cases. Occult malignancy prevalence in the combined data was 0.033%, representing four occult malignancies. Three out of the four would have been selected for full pathology preoperatively with use of the proposed criteria. Statistical analysis indicates that the predicted frequency of occult malignancy incidence in cases negative for the criteria is 0.01%, or 1/10,000. Conclusion: Application of the proposed criteria to adults undergoing tonsillectomy for benign indication identifies a subset of patients with an estimated incidence of occult malignancy similar to that reported for pediatric tonsillectomy, and potentially may permit safe elimination of pathologic analysis of their tonsil specimens. Level of Evidence: Pooled analysis of case series from the literature and a single institution, level 4.

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Cardio-cerebral infarction in left MCA strokes: a case series and literature review

Neurological Sciences ◽

10.1007/s10072-021-05628-x ◽

2021 ◽

Author(s):

Elochukwu Ibekwe ◽

Hera A. Kamdar ◽

Tamara Strohm

Keyword(s):

Literature Review ◽

Cerebral Infarction ◽

Case Series

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A case series of sodium glucose co-transporter-2 inhibitor (SGLT-2i) related diabetic ketoacidosis and literature review of the possible pathophysiology

Endocrine Abstracts ◽

10.1530/endoabs.44.p75 ◽

2016 ◽

Author(s):

Jawad Bashir ◽

Steve Bain ◽

Irfan Khan ◽

Tamar Saeed

Keyword(s):

Literature Review ◽

Diabetic Ketoacidosis ◽

Case Series

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Infrapopliteal Arterial Pseudoaneurysm Development Secondary to Blunt Trauma: Case Series and Literature Review

Vascular and Endovascular Surgery ◽

10.1177/1538574420907184 ◽

2020 ◽

Vol 54 (4) ◽

pp. 367-374

Author(s):

Matthew T. Chrencik ◽

Brian Caraballo ◽

John Yokemick ◽

Peter J. Pappas ◽

Brajesh K. Lal ◽

...

Keyword(s):

Literature Review ◽

Blunt Trauma ◽

Case Series ◽

Duplex Ultrasound ◽

Endovascular Coiling ◽

Skeletal Trauma ◽

Delay In Diagnosis ◽

Tibial Arteries ◽

Pulsatile Mass ◽

Orthopedic Injuries

Objectives: Infrapopliteal arterial pseudoaneurysms (IAP) following blunt trauma with associated orthopedic injuries are uncommon, often present in a delayed fashion, and encompass a diagnostic and therapeutic dilemma. Herein, we present a series of IAPs that were diagnosed following blunt trauma and their management. Methods: Case series consisting of 3 patients and a review of the international literature. Results: Our case series included 3 patients presenting with IAPs following blunt trauma with associated orthopedic injuries. They were all identified in a delayed manner (>3 weeks) after the orthopedic injuries were treated. All patients presented with pain and a pulsatile mass while one concurrently had neurologic deficits. The pseudoaneurysms were diagnosed by duplex ultrasound and confirmed by angiography to be originating from the tibioperoneal trunk, anterior tibial, and posterior tibial arteries respectively. Two patients were treated with surgical excision. Of these, one required an arterial bypass procedure while the other underwent direct ligation only. The third patient was treated by endovascular coiling. A literature review from 1950 to the present found 51 reported cases of IAP resulting from blunt trauma. Ninety percent of trauma-related infrapopliteal injuries occurred in men with a mean delay in diagnosis of 5.6 months (median 1.8 months) after injury. Since 1950, management has shifted from primarily ligation to incorporating minimally invasive endovascular techniques when appropriate. Conclusions: Infrapopliteal artery pseudoaneurysms are rare following blunt skeletal trauma. A delay in diagnosis often occurs and can result in major morbidity and extensive surgical intervention. We recommend a high index of suspicion and a thorough vascular examination in patients with lower extremity skeletal trauma to help identify and treat these injuries early and effectively.

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