An Algorithmic Approach to the Brain Biopsy—Part II

2006 ◽  
Vol 130 (11) ◽  
pp. 1639-1648
Author(s):  
Richard A. Prayson ◽  
B. K. Kleinschmidt-DeMasters
Keyword(s):  
Correct Diagnosis ◽  
Granulomatous Inflammation ◽  
Brain Biopsy ◽  
Thinking Skills ◽  
Flow Chart ◽  
Differential Diagnoses ◽  
Algorithmic Approach ◽  
Flow Diagrams ◽  
Flow Charts ◽  
The Brain

Abstract Context.—The formulation of appropriate differential diagnoses for a slide is essential to the practice of surgical pathology but can be particularly challenging for residents and fellows. Algorithmic flow charts can help the less experienced pathologist to systematically consider all possible choices and eliminate incorrect diagnoses. They can assist pathologists-in-training in developing orderly, sequential, and logical thinking skills when confronting difficult cases. Objective.—To present an algorithmic flow chart as an approach to formulating differential diagnoses for lesions seen in surgical neuropathology. Design.—An algorithmic flow chart to be used in teaching residents. Results.—Algorithms are not intended to be final diagnostic answers on any given case. Algorithms do not substitute for training received from experienced mentors nor do they substitute for comprehensive reading by trainees of reference textbooks. Algorithmic flow diagrams can, however, direct the viewer to the correct spot in reference texts for further in-depth reading once they hone down their diagnostic choices to a smaller number of entities. The best feature of algorithms is that they remind the user to consider all possibilities on each case, even if they can be quickly eliminated from further consideration. Conclusions.—In Part II, we assist the resident in arriving at the correct diagnosis for neuropathologic lesions containing granulomatous inflammation, macrophages, or abnormal blood vessels.

An Algorithmic Approach to the Brain Biopsy—Part I

2006 ◽  
Vol 130 (11) ◽  
pp. 1630-1638
Author(s):  
B. K. Kleinschmidt-DeMasters ◽  
Richard A. Prayson
Keyword(s):  
Brain Biopsy ◽  
Thinking Skills ◽  
Flow Chart ◽  
Differential Diagnoses ◽  
Logical Thinking ◽  
Algorithmic Approach ◽  
Flow Diagrams ◽  
Flow Charts ◽  
The Brain ◽  
Difficult Cases

Abstract Context.—The formulation of appropriate differential diagnoses for a slide is essential to the practice of surgical pathology but can be particularly challenging for residents and fellows. Algorithmic flow charts can help the less experienced pathologist to systematically consider all possible choices and eliminate incorrect diagnoses. They can assist pathologists-in-training in developing orderly, sequential, and logical thinking skills when confronting difficult cases. Objective.—To present an algorithmic flow chart as an approach to formulating differential diagnoses for lesions seen in surgical neuropathology. Design.—An algorithmic flow chart to be used in teaching residents. Results.—Algorithms are not intended to be final diagnostic answers on any given case. Algorithms do not substitute for training received from experienced mentors nor do they substitute for comprehensive reading by trainees of reference textbooks. Algorithmic flow diagrams can, however, direct the viewer to the correct spot in reference texts for further in-depth reading once they hone down their diagnostic choices to a smaller number of entities. The best feature of algorithms is that they remind the user to consider all possibilities on each case, even if they can be quickly eliminated from further consideration. Conclusions.—In Part I, we assist the resident in learning how to handle brain biopsies in general and how to distinguish nonneoplastic lesions that mimic tumors from true neoplasms.

A case of splenomegaly with RK-39 positivity: A diagnostic pitfall

2021 ◽  
pp. 004947552110206
Author(s):  
Prasad Dange ◽  
Ankesh Gupta ◽  
Richa Juneja ◽  
Renu Saxena
Keyword(s):  
Hereditary Spherocytosis ◽  
Correct Diagnosis ◽  
Young Male ◽  
Differential Diagnoses ◽  
Patient Evaluation ◽  
Serological Testing ◽  
Endemic Region ◽  
Careful Patient ◽  
Diagnostic Pitfall ◽  
Marked Splenomegaly

Long-standing moderate to marked splenomegaly suggests several differential diagnoses, both haematological and infectious, particularly leishmaniasis and malaria in endemic areas. Non-infectious causes may be missed in these regions, especially if pitfalls of serological testing are not considered. Careful patient evaluation is necessary to arrive at the correct diagnosis. We report a case of a young male whose hereditary spherocytosis was initially missed because of RK-39 positivity, splenomegaly and the fact that he hailed from an endemic region.

Approach to dyspnoea in pregnancy in the COVID-19 era

2020 ◽  
Vol 19 (4) ◽  
pp. 230-234
Author(s):  
Anita Banerjee ◽  
◽  
Lindsay A Arrandale ◽  
Srividhya Sankaran ◽  
Guy W Glover ◽  
...  
Keyword(s):  
Decision Making ◽  
Pregnant Women ◽  
Correct Diagnosis ◽  
Case Series ◽  
Differential Diagnoses ◽  
Shared Decision ◽  
First Case ◽  
Compromise Design ◽  
A Current ◽  
In Pregnancy

Importance: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. Objective: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. Design, setting and participants: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. Results: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.

Stereotactic Brain Biopsy in Eloquent Areas Assisted by Navigated Transcranial Magnetic Stimulation: a Technical Case Report

2018 ◽  
Vol 17 (3) ◽  
pp. E124-E129 ◽  
Author(s):  
Jiri Bartek ◽  
Gerald Cooray ◽  
Mominul Islam ◽  
Margret Jensdottir
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Magnetic Stimulation ◽  
Stereotactic Biopsy ◽  
Brain Biopsy ◽  
Awake Surgery ◽  
Histopathological Diagnosis ◽  
Navigated Transcranial Magnetic Stimulation ◽  
Stereotactic Brain Biopsy ◽  
Eloquent Areas ◽  
The Brain

Abstract BACKGROUND AND IMPORTANCE Stereotactic brain biopsy (SB) is an important part of the neurosurgical armamentarium, with the possibility of achieving histopathological diagnosis in otherwise inaccessible lesions of the brain. Nevertheless, the procedure is not without the risk of morbidity, which is especially true for lesions in eloquent parts of the brain, where even a minor adverse event can result in significant deficits. Navigated transcranial magnetic stimulation (nTMS) is widely used to chart lesions in eloquent areas, successfully guiding maximal safe resection, while its potential role in aiding with the planning of a stereotactic biopsy is so far unexplored. CLINICAL PRESENTATION Magnetic resonance imaging of a 67-yr-old woman presenting with dysphasia revealed a noncontrast enhancing left-sided lesion in the frontal and parietal pars opercularis. Due to the location of the lesion, nTMS was used to chart both primary motor and language cortex, utilizing this information to plan a safe SB trajectory and sampling area according to the initial work-up recommendations from the multidisciplinary neuro-oncology board. The SB was uneventful, with histology revealing a ganglioglioma, WHO I. The patient was discharged the following day, having declined to proceed with tumor resection (awake surgery) due to the non-negligible risk of morbidity. Upon 1- and 3-mo follow-up, she showed no signs of any procedure-related deficits. CONCLUSION nTMS can be implemented to aid with the planning of a stereotactic biopsy procedure in eloquent areas of the brain, and should be considered part of the neurosurgical armamentarium.

scholarly journals EXPANSION OF VISCERAL LEISHMANIASIS IN THE STATE OF RIO DE JANEIRO, BRAZIL: REPORT OF THE FIRST AUTOCHTHONOUS CASE IN THE MUNICIPALITY OF VOLTA REDONDA AND THE DIFFICULTY OF DIAGNOSIS

2014 ◽  
Vol 56 (3) ◽  
pp. 271-274 ◽  
Author(s):  
Luiz Henrique Conde Sangenis ◽  
Sebastião Roberto de Almeida Lima ◽  
Cíntia Xavier de Mello ◽  
Daniela Trindade Cardoso ◽  
Jurema Nunes Mello ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Symptom Onset ◽  
Urban Areas ◽  
Correct Diagnosis ◽  
Great Difficulty ◽  
The State ◽  
Differential Diagnoses ◽  
The North ◽  
Kala Azar ◽  
Epidemiological Changes

Visceral Leishmaniasis has been showing remarkable epidemiological changes in recent decades, with marked expansion and an emergence of cases in urban areas of the North, Southeast and Midwest regions of Brazil. The Kala-azar cases reported here, despite being very characteristic, presented a great difficulty of diagnosis, because the disease is not endemic in Volta Redonda. The child underwent two hospitalizations in different hospitals, but got the correct diagnosis only after 11 months of symptom onset. In this report we discuss the main differential diagnoses and call attention to the suspected symptoms of visceral leishmaniasis in patients with prolonged fever, hepatosplenomegaly and pancytopenia, even in areas not traditionally endemic for the disease.

scholarly journals 42. Study on the Brain Biopsy in Neurological Disorders of Children

1965 ◽  
Vol 7 ◽  
pp. 181b-181b
Author(s):  
Hirota HORINOUCHI ◽  
Seiji HOSODA ◽  
Hironobu SHIMADA ◽  
Fujio MATUMI ◽  
Yoshihiko OTA
Keyword(s):  
Neurological Disorders ◽  
Brain Biopsy ◽  
The Brain

scholarly journals Concordance of Bronchoalveolar Lavage Cytology with Transbronchial Lung Biopsies in Non-neoplastic Pulmonary Diseases

2021 ◽  
Author(s):  
Nischita Jayaraj ◽  
Kusuma Venkatesh
Keyword(s):  
Bronchoalveolar Lavage ◽  
Interstitial Pneumonia ◽  
Lung Diseases ◽  
Correct Diagnosis ◽  
Usual Interstitial Pneumonia ◽  
Granulomatous Inflammation ◽  
Pulmonary Diseases ◽  
Differential Count ◽  
Flexible Bronchoscope ◽  
Cell Counts

Introduction: In many pulmonary diseases, despite radiological & clinical investigations, laboratory tests and function studies, the diagnosis becomes difficult. Bronchoalveolar Lavage (BAL) is a minimally invasive method in which cells are collected from bronchial and alveolar spaces for cytology. This is facilitated by using a flexible bronchoscope with which a biopsy is taken following BAL. Bronchoscopy with BAL when used appropriately can offer correct diagnosis which in turn aids in proper management of the patient. Aim: To find the concordance of BAL findings with the histopathological features of Transbronchial Lung Biopsy (TBLB) in non-neoplastic lung diseases. Materials and Methods: It was a retrospective study conducted in Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka. A total of 40 patients presenting with clinico-radiological findings, suggesting a non-neoplastic lung disease in the year 2019, undergoing bronchoscopy with BAL and concurrent TBLB were chosen. The BAL fluid was processed and differential count of cells was done to classify according to the American Thoracic Society Guidelines. Concordance was checked between the diagnoses made on TBLB and BAL analysis. Results: In the present study, a total of 40 cases were included of which 13 (32.5%) cases showed neutrophilic, 16 (40%) cases showed lymphocytic, 5 (12.5%) cases showed eosinophilic and 6 (15%) cases showed normal cellular distribution on BAL cytology. Diagnoses on studying TBLB included nine cases of Nonspecific Interstitial Pneumonia, seven cases of Usual Interstitial Pneumonia, six cases of Bronchiolitis Obliterans Organising Pneumonia, three cases of Bronchiolitis, two cases each of pulmonary tuberculosis and granulomatous inflammation. There was one case each of actinomycosis, sarcoidosis, lung abscess and mucor mycosis. Normal histology was noted in seven cases. The sensitivity of BAL fluid analysis was found to be 84.84% and the concordance was 80%. The Kappa value obtained was 0.71 indicating good agreement/concordance between BAL cytology and TBLB. Conclusion: The data from the current study suggest that differential cell counts in BAL provide diagnostic information of fundamental importance in frequently occurring non-neoplastic lung diseases in the community.

scholarly journals Central nervous system paracoccidioidomycosis. Report of a case successfully treated with Itraconazol

2000 ◽  
Vol 42 (4) ◽  
pp. 231-234 ◽  
Author(s):  
Luis A. VILLA ◽  
Angela TOBÓN ◽  
Antonio RESTREPO ◽  
Daniel CALLE ◽  
David S. ROSERO ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Improvement ◽  
Brain Biopsy ◽  
Yeast Cells ◽  
Control Drug ◽  
Antibody Titers ◽  
The Central Nervous System ◽  
Clonic Seizures ◽  
The Brain

Paracoccidioidomycosis (PCM) is a primary pulmonary infection that often disseminates to other organs and systems. Involvement of the central nervous system (CNS) is rare and due to the fact that both clinical alertness and establishment of the diagnosis are delayed, the disease progresses causing serious problems. We report here a case of neuroparacoccidioidomycosis (NPCM), observed in a 55 year-old male, who consulted due to neurological symptoms (left hemiparesis, paresthesias, right palpebral ptosis, headache, vomiting and tonic clonic seizures) of a month duration. Upon physical examination, an ulcerated granulomatous lesion was observed in the abdomen. To confirm the diagnosis a stereotactic biopsy was taken; additionally, mycological tests from the ulcerated lesion and a bronchoalveolar lavage were performed. In the latter specimens, P. brasiliensis yeast cells were visualized and later on, the brain biopsy revealed the presence of the fungus. Treatment with itraconazole (ITZ) was initiated but clinical improvement was unremarkable; due to the fact that the patient was taking sodium valproate for seizure control, drug interactions were suspected and confirmed by absence of ITZ plasma levels. The latter medication was changed to clonazepam and after several weeks, clinical improvement began to be noticed and was accompanied by diminishing P. brasiliensis antigen and antibody titers. In the PCM endemic areas, CNS involvement should be considered more often and the efficacy of itraconazole therapy should also be taken into consideration.

scholarly journals Simultaneous occurrence of brain tumor and myeloradiculopathy in schistosomiasis mansoni: case report

2009 ◽  
Vol 42 (3) ◽  
pp. 338-341 ◽  
Author(s):  
José Roberto Lambertucci ◽  
Silvio Roberto Souza-Pereira ◽  
Tânia Antunes Carvalho
Keyword(s):  
Puerto Rico ◽  
Brain Tumor ◽  
Brain Biopsy ◽  
The United States ◽  
Clinical State ◽  
Simultaneous Occurrence ◽  
Resonance Imaging ◽  
Schistosomiasis Mansoni ◽  
One Year ◽  
The Brain

Simultaneous occurrence of brain tumor and myeloradiculopathy in cases of Manson's schistosomiasis have only rarely been described. We report the case of a 38-year-old man who developed seizures during a trip to Puerto Rico and in whom a brain tumor was diagnosed by magnetic resonance imaging: brain biopsy revealed the diagnosis of schistosomiasis. He was transferred to a hospital in the United States and, during hospitalization, he developed sudden paraplegia. The diagnosis of myeloradiculopathy was confirmed at that time. He was administered praziquantel and steroids. The brain tumor disappeared, but the patient was left with paraplegia and fecal and urinary dysfunction. He has now been followed up in Brazil for one year, and his clinical state, imaging examinations and laboratory tests are presented here.

Fatal Parasitic Meningoencephalomyelitis Caused By Halicephalobus deletrix: A Case Report and Review of the Literature

2010 ◽  
Vol 134 (4) ◽  
pp. 625-629
Author(s):  
Sarah L. Ondrejka ◽  
Gary W. Procop ◽  
Keith K. Lai ◽  
Richard A. Prayson
Keyword(s):  
Fatal Case ◽  
Brain Biopsy ◽  
Altered Mental Status ◽  
Brain Parenchyma ◽  
Review Of The Literature ◽  
Inflammatory Infiltration ◽  
Granulomatous Vasculitis ◽  
Helminthic Infection ◽  
The Central Nervous System ◽  
The Brain

Abstract Infection with the saprophagous nematode Halicephalobus species is uncommon but has been reported in horses worldwide. Only 3 human cases have been previously described, all of which have been fatal. We report a fourth fatal case, which occurred in a 39-year-old woman who presented with meningeal signs, altered mental status, and a prodromal pruritic rash. Diagnostic evaluation included an open brain biopsy, which was diagnosed as granulomatous vasculitis. The patient subsequently died after a course of steroids and cyclophosphamide. At autopsy, a robust perivascular mixed inflammatory infiltration of the brain parenchyma, meninges, and ventricular system was present with larval forms and mature nematodes morphologically consistent with Halicephalobus deletrix. Although extremely rare, this organism needs to be considered in the differential diagnosis of human helminthic infection of the central nervous system.

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