Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis

We report the unique finding of a petrous apex cholesterol granuloma associated with a paraganglioma, also known as a glomus jugulare tumor, in a 52-year-old woman who presented to our department with pulsatile tinnitus, hearing loss, aural fullness, and disequilibrium. She had been treated for a petrous apex cholesterol granuloma 20 years earlier, at which time she had undergone drainage of the granuloma via subtotal petrous apicectomy. When she came to our facility approximately 20 years later, she had signs and symptoms consistent with a jugular paraganglioma, which was likely to have been present at the time of her initial presentation for the cholesterol granuloma. In fact, microscopic bleeding from the paraganglioma might have led to the formation of the cholesterol granuloma. The metachronous presentation of these two entities, which to our knowledge has not been reported previously in the literature, indicates the potential association of paragangliomas with the formation of cholesterol granulomas of the petrous apex.

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Presentation and treatment of carotid cavernous aneurysms

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000200009 ◽

2008 ◽

Vol 66 (2a) ◽

pp. 189-193 ◽

Cited By ~ 18

Author(s):

Lucas Perez de Vasconcellos ◽

Juan Antônio Castro Flores ◽

José Carlos Esteves Veiga ◽

Mário Luiz Marques Conti ◽

Pedro Shiozawa

Keyword(s):

Clinical Features ◽

Internal Carotid ◽

Signs And Symptoms ◽

Initial Presentation ◽

Neurological Deficits ◽

Neurovascular Compression ◽

Neurological Signs ◽

Neurological Prognosis ◽

Pain Symptoms ◽

Carotid Aneurysms

We analyzed a group of patients with the diagnosis of internal carotid aneurysms in its intracavernous segment, with emphasis in prevalence, clinical features, treatments, evolution and neurological prognosis. Neurological signs and symptoms at initial presentation were registered and compared with final outcome. Patients were divided into two stratified groups, one with 19 patients which underwent interventionist treatment, and another with 21 patients who were conservatively treated. The present study demonstrated that intervention is significantly correlated with a better prognosis considering evolution of pain symptoms secondary to neurovascular compression (p=0,002). Regarding neurological deficits, an interventionist approach was also significantly correlated with better outcome in comparison with initial presentation (p=0,008). These results indicate that interventionist treatment determines improvement or resolution of pain symptoms in comparison with patients conservatively treated, as well as stabilization or partial improvement of neuro-ophthalmological deficits.

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Kawasaki Shock Syndrome with Initial Presentation as Neck lymphadenitis: A Case Report

Children ◽

10.3390/children9010056 ◽

2022 ◽

Vol 9 (1) ◽

pp. 56

Author(s):

Yi-Ting Cheng ◽

Yu-Shin Lee ◽

Jainn-Jim Lin ◽

Hung-Tao Chung ◽

Yhu-Chering Huang ◽

...

Keyword(s):

Coronary Artery ◽

Early Recognition ◽

Systemic Vasculitis ◽

Pediatric Population ◽

Signs And Symptoms ◽

Initial Presentation ◽

Small Subset ◽

Cervical Lymphadenitis ◽

Initial Manifestation ◽

Delay In Diagnosis

Kawasaki disease (KD) is an acute systemic vasculitis of unknown cause that mainly affects infants and children and can result in coronary artery complications if left untreated. A small subset of KD patients with fever and cervical lymphadenitis has been reported as node-first-presenting KD (NFKD). This type of KD commonly affects the older pediatric population with a more intense inflammatory process. Considering its unusual initial presentation, a delay in diagnosis and treatment increases the risk of coronary artery complications. Herein, we report the case of a 9-year-old female with fever and neck mass that rapidly deteriorated to shock status. A diagnosis of KD was made after the signs and symptoms fulfilled the principal diagnostic criteria. The patient’s heart failure and blood pressure improved dramatically after a single dose of intravenous immunoglobulin. This case reminds us that NFKD could be the initial manifestation of KDSS, which is a potentially fatal condition. We review the literature to identify the overlapping characteristics of NFKD and KDSS, and to highlight the importance of early recognition of atypical KD regardless of age. We conclude that unusually high C-reactive protein, neutrophilia, and thrombocytopenia serve as supplemental laboratory indicators for early identification of KDSS in patients with NFKD.

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Metastatic pheochromocytoma and paraganglioma: signs and symptoms related to catecholamine secretion

Discover Oncology ◽

10.1007/s12672-021-00404-x ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Minghao Li ◽

Christina Pamporaki ◽

Stephanie M. J. Fliedner ◽

Henri J. L. M. Timmers ◽

Svenja Nölting ◽

...

Keyword(s):

Urinary Excretion ◽

Clinical Data ◽

Future Development ◽

Signs And Symptoms ◽

Lower Proportion ◽

Initial Presentation ◽

Metastatic Tumors ◽

Cumulative Score ◽

Biochemical Diagnosis ◽

High Urinary Excretion

Abstract Background The presence or future development of metastatic pheochromocytomas or paragangliomas (mPPGLs) can be difficult to diagnose or predict at initial presentation. Since production of catecholamines from mPPGLs is different from non-metastatic tumors (non-mPPGLs), this study aimed to clarify whether presenting catecholamine-related signs and symptoms (cSS) might also differ. Methods The study included 249 patients, 43 with mPPGL and 206 with non-mPPGL. Clinical data at the time of biochemical diagnosis (i.e. at entry into the study) were used to generate a cumulative score of cSS for each patient. Results Patients with mPPGL were significantly younger (43.3 ± 14 vs. 48.9 ± 16.1 years) and included a lower proportion of females (39.5% vs. 60.7%) than patients with non-mPPGLs. Frequencies of signs and symptoms did not differ between the two groups. Patients with mPPGLs had lower (P < 0.001) urinary excretion of epinephrine (3.5 (IQR, 1.9—6.5) µg/day) than those with non-mPPGLs (19.1 (IQR, 4.3—70.2) µg/day). There was no difference in urinary excretion of norepinephrine. In patients with mPPGLs a high cSS score was associated with high urinary excretion of norepinephrine and normetanephrine. In contrast, in patients with non-mPPGLs, a high cSS was associated with high urinary excretion of epinephrine and metanephrine. Conclusion Although presenting signs and symptoms were associated with production of norepinephrine in patients with mPPGLs and of epinephrine in patients with non-mPPGLs, there were no differences in signs and symptoms between the two groups. Therefore, consideration of signs and symptoms does not appear helpful for distinguishing patients with and without mPPGLs.

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An undiagnosed myasthenia gravis presenting as isolated recurrent acute respiratory failure

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.91961 ◽

2012 ◽

Vol 03 (01) ◽

pp. 80-82

Author(s):

Ram Shri Sharma ◽

Nalini Sharma ◽

ME Yeolekar

Keyword(s):

Emergency Department ◽

Differential Diagnosis ◽

Critical Care ◽

Respiratory Failure ◽

Acute Respiratory Failure ◽

Myasthenia Gravis ◽

Care Setting ◽

Signs And Symptoms ◽

Initial Presentation ◽

Speech Therapist

ABSTRACTAcute respiratory failure is an uncommon initial presentation of myasthenia gravis (MG). In our case a 22-year-old woman of unrecognized MG presented to the emergency department with isolated respiratory failure as the first presenting symptom. Initially she presented with dysphonia and was managed by speech therapist and ENT surgeons for 3 months. Subsequently, she presented with signs and symptoms of sepsis and went into acute respiratory failure. This case highlights the need to consider MG in the differential diagnosis of an otherwise unexplained respiratory failure in the critical care setting.

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Coexistence of Pulmonary tuberculosis and lung cancer

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v6i1.18313 ◽

2017 ◽

Vol 6 (1) ◽

pp. 11-13 ◽

Cited By ~ 1

Author(s):

Sandeep Mahajan ◽

Vijay Gotwal ◽

Neeraj Lata ◽

P.S. Nisanth

Keyword(s):

Lung Cancer ◽

Pulmonary Tuberculosis ◽

Lung Carcinoma ◽

Signs And Symptoms ◽

Interesting Case ◽

Initial Presentation ◽

Mortality And Morbidity ◽

Delay In Diagnosis ◽

Lung Malignancy ◽

Underlying Disorder

Pulmonary Tuberculosis can co-exist with lung malignancy masking the underlying disorder leading to delay in diagnosis and management. Here we present an interesting case of a 72 year old female who on initial presentation was diagnosed with tuberculosis but later developed plural effusion during treatment and on investigation was found to have an underlying lung malignancy.Introduction: Pulmonary Tuberculosis and lung carcinoma are the two co morbidities that have been shown in many studies to coexist. Many of Signs and symptoms of Pulmonary Tuberculosis mimics lung carcinoma and coexistence increases mortality and morbidity. So we are presenting a case which had pulmonary Tuberculosis and later developed carcinoma lung.

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Vestibular schwannoma (acoustic neuroma) mimicking temporomandibular disorders: a case report

Journal of Applied Oral Science ◽

10.1590/s1678-77572006000600016 ◽

2006 ◽

Vol 14 (6) ◽

pp. 476-481 ◽

Cited By ~ 13

Author(s):

Maurício A. Bisi ◽

Caio M. P. Selaimen ◽

Karen D. Chaves ◽

Melissa C. Bisi ◽

Márcio L. Grossi

Keyword(s):

Trigeminal Neuralgia ◽

Vestibular Schwannoma ◽

Acoustic Neuroma ◽

Temporomandibular Disorders ◽

Signs And Symptoms ◽

Special Treatment ◽

Intracranial Tumors ◽

Neuralgic Pain ◽

Magnetic Resonance Imaging Mri ◽

The Relationship

Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma). Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI) has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case.

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Oral presentation of haematological disease

Faculty Dental Journal ◽

10.1308/204268512x13312096186523 ◽

2012 ◽

Vol 3 (2) ◽

pp. 104-111

Author(s):

David O’Connor ◽

Rupert Hipkins ◽

Jim Murray

Keyword(s):

Oral Presentation ◽

Healthcare Professionals ◽

Signs And Symptoms ◽

Initial Presentation ◽

Haematological Disease ◽

Timely Diagnosis ◽

Dental Practitioner ◽

Dental Practitioners

Oral signs and symptoms can become apparent early in the onset of haematological disease, meaning initial presentation may be to the dental practitioner. It is therefore essential that dental practitioners have an awareness of such signs, allowing suitable referral and timely diagnosis of these disorders. In this review we will provide an introduction to both benign and malignant haematological diseases, particularly concentrating on the associated oral changes. We will also provide advice on further investigation and management of these conditions, relevant to all healthcare professionals working within dentistry.

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Cerebral venous sinus thrombosis as the initial presentation of systemic lupus erythematosus

Lupus ◽

10.1177/0961203319897120 ◽

2020 ◽

Vol 29 (2) ◽

pp. 213-215 ◽

Cited By ~ 1

Author(s):

T Chandra ◽

J S Tilstra

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Sinus Thrombosis ◽

Treatment Strategies ◽

Signs And Symptoms ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Initial Presentation ◽

Systemic Lupus ◽

Venous Sinus Thrombosis

Systemic lupus erythematosus (SLE) is a hypercoagulable state due to a variety of mechanisms. Herein, we discuss the case of a 40-year-old gentleman who presented with cerebral venous sinus thrombosis (CVST) as the first manifestation of underlying SLE. On initial presentation, he did not endorse any other signs and symptoms to suggest the presence of an autoimmune condition. Work-up revealed an absence of antiphospholipid antibodies. Further evaluation uncovered the underlying etiology of the CVST as SLE-induced nephrotic syndrome. The existing literature on CVST suggests that there are only two other biopsy-proven cases of lupus nephritis leading to nephrotic range proteinuria as the etiology for CVST. Given the rarity of this presentation, there are no clearly delineated treatment strategies.

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Mood Disorders Associated with Acoustic Neuromas

The International Journal of Psychiatry in Medicine ◽

10.2190/50pt-t9yd-ackj-1gux ◽

1994 ◽

Vol 24 (1) ◽

pp. 31-43 ◽

Cited By ~ 12

Author(s):

Balu Kalayam ◽

Robert C. Young ◽

Gabriel K. Tsuboyama

Keyword(s):

Acoustic Neuroma ◽

Psychiatric Symptoms ◽

Memory Loss ◽

Signs And Symptoms ◽

Persecutory Delusions ◽

Psychological Reactions ◽

Mood Changes ◽

Acoustic Neuromas ◽

Psychiatric Admissions ◽

Reticular System

Objective: The primary purpose of this article is the presentation of three cases of manic and mixed states associated with an acoustic neuroma, and review of the literature on psychiatric symptoms accompanied by the tumor. Methods: The cases were identified from 830 consecutive inpatient psychiatric admissions over age fifty-five years. Patients were assessed using a Structured Clinical Interview (SCID-R), and met DSM-III-R criteria for the diagnosis of bipolar disorder. The psychopathology seen in acoustic neuroma patients and the pathophysiologic mechanisms proposed to explain them are reviewed. Results: The cases we report differ from other cases in the literature in that psychiatric symptoms began pre-operatively and remained for long periods post-operatively. The psychiatric signs and symptoms reported in acoustic neuroma patients are usually described as transient, and these include mood changes, agitation, persecutory delusions, hallucinations, and memory loss and confusional episodes. The disruption of brainstem structures including the auditory pathways, the cerebellum and the ascending reticular system may contribute to mood changes. Systematic studies are necessary to examine their relationship. Although psychological reactions attributable to surgery and facial paralysis may serve as contributory factors the evidence for their role was not striking in the cases we report.

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