scholarly journals Vanishing hyperintensity in MRI: Vascular or epileptic origin?

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Rodriguez-Rivas Luis Ricardo ◽  
◽  
Reyes-Vaca Jorge Guillermo ◽  
Vázquez-Guevara Damaris Daniela ◽  
Rodriguez-Leyva Ildefonso ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Complete Resolution ◽  
Clinical Case ◽  
Mri Imaging ◽  
Cerebral Malformation ◽  
Vascular Abnormality ◽  
Ischemic Event ◽  
Exact Etiology ◽  
Work Up

Status Epilepticus and epilepsy-related MRI vanishing changes have been reported in the literature since the 1980s; hypoxia and hypoperfusion have been related to these image modifications. These alterations and their disappearing characteristics can cause trouble among work up and their diagnosis, especially if there is no exact etiology of what is causing seizures. We present a case of a 37-year-old righthanded man with a 6-year history followed up after seizure debut, with no exact etiology at the first event, considering an ischemic event as etiology. After a six-year follow-up seizure-free and no sequels, the patient newly developed aphasia, seizures, and status epilepticus, with a now evident vascular abnormality (cavernous cerebral malformation) etiology in MRI imaging. The cumbersomeness of the clinical picture in its presentation, the seriousness to which it reached, and the complete resolution of the problem with medical treatment make this clinical case especially attractive.

scholarly journals Canine pemphigus folliaceus: report of five clinical case

2018 ◽  
Vol 52 (4) ◽  
pp. 273 ◽  
Author(s):  
M. V. LIAPI (Μ.Β. ΛΙΑΠΗ) ◽  
M. N. SARIDOMICHELAKIS (Μ.Ν. ΣΑΡΙΔΟΜΙΧΕΛΑΚΗΣ) ◽  
A. F. KOUTINAS (Α. Φ. ΚΟΥΤΙΝΑΣ) ◽  
S. LEKKAS (Σ. ΛΕΚΚΑΣ)
Keyword(s):  
Complete Resolution ◽  
Clinical Case ◽  
Spontaneous Remission ◽  
Skin Lesions ◽  
Response To Treatment ◽  
Allergic Dermatitis ◽  
Lost To Follow Up ◽  
Cleft Formation ◽  
Upper Third

Pemphigus folliaceus (PF), which is considered the most common autoimmune skin disease in the dog, is associated with the formation of autoantibodies directed against the desmosomes of the upper third of the epidermis, that result in loss of keratinocyte adhesion (acantholysis) and subsequent epidermal cleft formation. The clinical and histopathological findings, along with the response to treatment in 5 PF cases, either idiopathic (3/5) or secondary to trimethoprim-sulfonamides (1/5) and to allergic dermatitis (1/5), are presented and discussed, accordingly. All the 5 dogs exhibited hypotrichosis-alopecia (4/5), erythema (4/5), vesicles (1/5), pustules (5/5), crusts (5/5), epidermal collarettes (3/5), excoriations (1/5), erosions (3/5), ulcers (1/5), fissures (1/5), lichenification, thickening and folding of the skin (1/5), and footpad hyperkeratosis (1/5), that were pruritic in 3 of them. These lesions were located on the head (4/5), pinnae (4/5), limbs (3/5), body trunk (3/5) and the footpads (2/5). Diagnosis was based on the results of lesionai histopathology where the most striking finding was the presence of subcorneal pustules filled with normally looking neutrophils and acanthocytes. Moreover, pustule or crust cytology that was carried out in 3 cases, revealed clusters of acantholytic cells in 2 dogs. The treatment, that was instituted in 2/5 dogs and resulted in a complete resolution of skin lesions, was based on prednisolone in immunosuppressive dosage along with azathioprine (PF secondary to allergic dermatitis), or on a combination of dapsone, Oxytetracycline and vitamin E (idiopathic PF). The remaining 3 cases were left untreated, because one showed a spontaneous remission following withdrawal of the offending medication and the other 2 were lost to follow-up.

scholarly journals SAT-273 Case of Mistaken Identity?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Carlos Pla
Keyword(s):  
Muscle Weakness ◽  
Pituitary Adenomas ◽  
Complete Resolution ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Pituitary Macroadenoma ◽  
Patient Reported ◽  
Work Up

Abstract Introduction Pituitary adenomas occur in 10-15% of patients and the majority are benign. Prolactinomas are the most common form of secretory pituitary adenoma. Pituitary apoplexy, a medical emergency with resulting visual loss and hormonal hyposecretion, requires rapid surgical intervention. We present a case of pituitary macroadenoma that underwent pituitary resection for acute visual disturbance which was later discovered to be caused by undiagnosed demyelinating disease. Clinical Case Patient is a 32-year-old male who presented initially with complain of fatigue and decreased libido. Work up revealed elevated prolactin level and low testosterone. MRI showed a 2x3cm pituitary macroadenoma. At moment of diagnosis, patient was otherwise asymptomatic. He was started on bromocriptine. During follow up visits, patient reported visual disturbance. First MRI in our clinic showed no suprasellar extension, no impingement of optic chiasm and nonspecific white matter disease. At that time, visual field testing showed left temporal defect in superior quadrant. Follow up MRI 1 year later continued to show a stable macroadenoma without impingement of the optic chiasm, but patient reported progressive left vision disturbance and new right vision loss. He was evaluated in the emergency room where he was treated for pituitary apoplexy with steroids and surgery. Vision improved the next day. Despite uncomplicated post-operative course, patient developed proximal muscle weakness and exam notable for diffuse motor deficit in bilateral lower extremities with hyperreflexia. Endocrinology workup was negative for hypercortisolism and ophthalmology diagnosed him with optic neuropathy. Neurology evaluation led to a diagnosis of multiple sclerosis (MS). Patient was started on natalizumab with complete resolution of all visual and muscle symptoms. Clinical lesson Our patient presented with complaints of fatigue, decreased libido and work up that showed a macroprolactinoma without MRI evidence of optic chiasm impingement. During treatment, he developed acute visual deficits that were attributed to pituitary apoplexy. This visual disturbance improved after surgery and use of high dose IV steroids, with the latter likely treating what had been an MS flare. In hindsight, ophthalmologic evaluation before surgery had shown new color blindness, a sign of optic neuropathy. Despite temporary relief, patient progressed to develop new muscle weakness and recurrent visual disturbance which led to the diagnosis of MS. Since being diagnosed and treated for MS, he has had complete resolution of his symptoms. This case stresses the importance of considering other etiologies for visual defects in patients with pituitary adenomas.

scholarly journals Intrahepatic splenosis mimicking hepatocellular carcinoma

2021 ◽  
Vol 25 (4) ◽  
pp. 115-121
Author(s):  
B. M. Medvedeva ◽  
A. B. Lukianchenko ◽  
K. A. Romanova ◽  
E. A. Moroz ◽  
A. N. Polyakov
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Pancreatitis ◽  
Clinical Case ◽  
Definitive Diagnosis ◽  
Histopathological Analysis ◽  
Mri Imaging ◽  
Resected Liver ◽  
History Of ◽  
Intrahepatic Splenosis

We present a rare clinical case of a 37-year-old man who had intrahepatic splenosis (IHS) mimics hepatocellular carcinoma on CT/MRI imaging. The patient with a history of splenectomy 14 years ago had no specific complains and the lesion was found incidentally during follow up imaging for the chronic pancreatitis. Definitive diagnosis of IHS was possible with post-operative histopathological analysis of the resected liver.

Guideline for radioimmunotherapy of rituximab relapsed or refractory CD20+ follicular B-cell nonHodgkin´s lymphoma

2004 ◽  
Vol 43 (05) ◽  
pp. 171-176 ◽  
Author(s):  
T. Behr ◽  
F. Grünwald ◽  
W. H. Knapp ◽  
L. Trümper ◽  
C. von Schilling ◽  
...  
Keyword(s):  
Quality Control ◽  
Quality Management ◽  
Medical Physics ◽  
Essential Elements ◽  
Background Information ◽  
After Care ◽  
Complete Treatment ◽  
Close Cooperation ◽  
Work Up

Summary:This guideline is a prerequisite for the quality management in the treatment of non-Hodgkin-lymphomas using radioimmunotherapy. It is based on an interdisciplinary consensus and contains background information and definitions as well as specified indications and detailed contraindications of treatment. Essential topics are the requirements for institutions performing the therapy. For instance, presence of an expert for medical physics, intense cooperation with all colleagues committed to treatment of lymphomas, and a certificate of instruction in radiochemical labelling and quality control are required. Furthermore, it is specified which patient data have to be available prior to performance of therapy and how the treatment has to be carried out technically. Here, quality control and documentation of labelling are of greatest importance. After treatment, clinical quality control is mandatory (work-up of therapy data and follow-up of patients). Essential elements of follow-up are specified in detail. The complete treatment inclusive after-care has to be realised in close cooperation with those colleagues (haematology-oncology) who propose, in general, radioimmunotherapy under consideration of the development of the disease.

Autoimmune Pancreatitis – Diagnosis, Management and Longterm Follow-up

2014 ◽  
Vol 23 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Suvadip Chatterjee ◽  
Kofi W. Oppong ◽  
John S. Scott ◽  
Dave E. Jones ◽  
Richard M. Charnley ◽  
...  
Keyword(s):  
Autoimmune Pancreatitis ◽  
Rare Condition ◽  
Team Approach ◽  
Diagnostic Challenge ◽  
Multisystem Disorder ◽  
North East ◽  
The North ◽  
Work Up ◽  
Igg4 Level

Background & Aims: Autoimmune pancreatitis (AIP) is a fibroinflammatory condition affecting the pancreas and could present as a multisystem disorder. Diagnosis and management can pose a diagnostic challenge in certain groups of patients. We report our experience of managing this condition in a tertiary pancreaticobiliary centre in the North East of England.Methods: Patients were identified from a prospectively maintained database of patients diagnosed with AIP between 2005 and 2013. Diagnosis of definite/probable AIP was based on the revised HISORt criteria. When indicated, patients were treated with steroids and relapses were treated with azathioprine. All patients have been followed up to date.Results: Twenty-two patients were diagnosed with AIP during this period. All patients had pancreatic protocol CT performed while some patients had either MR or EUS as part of the work up. Fourteen out of 22 (64%) had an elevated IgG4 level (mean: 10.9 g/L; range 3.4 - 31 g/L). Four (18%) patients underwent surgery. Extrapancreatic involvement was seen in 15 (68%) patients, with biliary involvement being the commonest. Nineteen (86%) were treated with steroids and five (23%) required further immunosuppression for treatment of relapses. The mean follow up period was 36.94 months (range 7 - 94).Conclusion: Autoimmune pancreatitis is being increasingly recognized in the British population. Extrapancreatic involvement, particularly extrahepatic biliary involvement seems to be a frequent feature.Diagnosis should be based on accepted criteria as this significantly reduces the chances of overlooking malignancy. Awareness of this relatively rare condition and a multi-disciplinary team approach will help us to diagnose and treat this condition more efiectively thereby reducing unnecessary interventions.

Thyroidectomy in a patient with a giant multinodular nontoxic cervical retrosternal goiter

2020 ◽  
pp. 97-99
Author(s):  
U. V. Kukhtenko ◽  
O. A. Kosivtsov ◽  
L. A. Ryaskov ◽  
E. I. Abramian
Keyword(s):  
Surgical Treatment ◽  
Clinical Case ◽  
Clinical Signs ◽  
Disease Relapse ◽  
Cardiac Pathology ◽  
Nontoxic Goiter ◽  
Retrosternal Goiter

A clinical case of successful surgical treatment of a patient with a giant cervical retrosternal nontoxic goiter with severe cardiac pathology is presented. Thyroidectomy from cervical access without sternotomy was performed. At the follow-up examination 5 months after the operation, instrumental and clinical signs of disease relapse were not detected.

Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

2020 ◽  
Vol 13 (12) ◽  
pp. e235986
Author(s):  
Alexander Tindale ◽  
James Jackson ◽  
Darina Kohoutova ◽  
Panagiotis Vlavianos
Keyword(s):  
Portal Vein ◽  
Complete Resolution ◽  
Chylous Ascites ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Portal Vein Stenosis ◽  
First Case ◽  
Vein Stenosis ◽  
Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

scholarly journals The first multicentre study on coronary anomalies in the Netherlands: MuSCAT

2021 ◽  
Author(s):  
C. J. Koppel ◽  
B. W. Driesen ◽  
R. J. de Winter ◽  
A. E. van den Bosch ◽  
R. van Kimmenade ◽  
...  
Keyword(s):  
Coronary Artery ◽  
The Netherlands ◽  
Multicentre Study ◽  
Ct Angiography ◽  
Patient Group ◽  
Care Pathway ◽  
Coronary Anomalies ◽  
Work Up ◽  
Ischaemia Detection

Abstract Background Current guidelines on coronary anomalies are primarily based on expert consensus and a limited number of trials. A gold standard for diagnosis and a consensus on the treatment strategy in this patient group are lacking, especially for patients with an anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) with an interarterial course. Aim To provide evidence-substantiated recommendations for diagnostic work-up, treatment and follow-up of patients with anomalous coronary arteries. Methods A clinical care pathway for patients with ACAOS was established by six Dutch centres. Prospectively included patients undergo work-up according to protocol using computed tomography (CT) angiography, ischaemia detection, echocardiography and coronary angiography with intracoronary measurements to assess anatomical and physiological characteristics of the ACAOS. Surgical and functional follow-up results are evaluated by CT angiography, ischaemia detection and a quality-of-life questionnaire. Patient inclusion for the first multicentre study on coronary anomalies in the Netherlands started in 2020 and will continue for at least 3 years with a minimum of 2 years of follow-up. For patients with a right or left coronary artery originating from the pulmonary artery and coronary arteriovenous fistulas a registry is maintained. Results Primary outcomes are: (cardiac) death, myocardial ischaemia attributable to the ACAOS, re-intervention after surgery and intervention after initially conservative treatment. The influence of work-up examinations on treatment choice is also evaluated. Conclusions Structural evidence for the appropriate management of patients with coronary anomalies, especially (interarterial) ACAOS, is lacking. By means of a structured care pathway in a multicentre setting, we aim to provide an evidence-based strategy for the diagnostic evaluation and treatment of this patient group.

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