Regression of lumbar disc herniation with non-surgical treatment: a case report

To date, only a few reports have described the regression of lumbar disc herniation, which may be because of a failure to follow up patients treated conservatively. We report a case of a 25-year-old man who presented with a 2-month history of pain and soreness owing to lumbar disc herniation. He was managed conservatively, and his presenting symptoms and scoliosis gradually decreased over approximately 5 months. Two years later, he returned unexpectedly and was advised to undergo magnetic resonance imaging, which revealed regression of the disc herniation; the patient also confirmed that the pain had not recurred. After 8 months, he underwent repeat magnetic resonance imaging, and the findings pertaining to disc herniation were normal. Our findings suggest that previous cases should be retrospectively studied to establish a prediction model for the outcomes of conservative treatment in patients with lumbar disc herniation. We also emphasize the significance of selecting suitable patients for conservative treatment to obtain the best therapeutic outcomes. The CARE guidelines have been followed in the reporting of this case.

Pituitary Microadenoma Treated with Individualized Homeopathic Medicine: A Case Report

Background Pituitary adenomas are common benign tumors of the pituitary gland with an overall estimated prevalence of 16.7%. As per the revised World Health Organization (WHO) classification, these tumors are identified by their histological subtypes and are designated by their pituitary cell lineage instead of the hormone they produce. The lactotroph adenoma is the most common subtype of hormone-producing pituitary adenoma. Surgery is the mainstay of treatment, but complications are encountered. So far, there is no reported study evaluating individualized homeopathic intervention in pituitary adenoma in peer-reviewed journals. Methods This case study describes a case of functional lactotroph microadenoma with history of failed surgical treatment and heavy intrasellar hemorrhage occurring during the surgery. Phosphorus was prescribed as an individualized homeopathic medicine on the basis of symptoms—hemorrhagic complication during surgical procedure and aggravation of headache thereafter. Results There was a marked subjective improvement along with complete tumor regression, as evidenced by repeat magnetic resonance imaging scans. The Modified Naranjo Criteria total score was +10 out of a possible +13, providing some evidence to attribute the clinical outcome with the homeopathic intervention. Conclusion This case study reconfirms the association between increased frequency of headaches and pituitary hemorrhage among cases of lactotroph adenoma. It also suggests that individualized homeopathic treatment may be helpful in pituitary adenomas with increased risk of complications such as intrasellar hemorrhage.

SPONTANEOUS RESOLUTION OF PRIMARY HYPERCORTISOLISM OF CUSHING DISEASE AFTER PITUITARY HEMORRHAGE

Objective: To describe a case of spontaneous resolution of primary hypercortisolism from Cushing disease (CD) due to pituitary apoplexy (PA). Methods: Clinical, laboratory, and pathologic information are described. Results: A 59-year-old female presented with a headache, a 2.3 cm sellar mass with a questionable hemorrhagic component, and clinical signs of hypercortisolism. On further evaluation, she had an increased 24-hour urine free cortisol, abnormal serum cortisol during a low dose dexamethasone suppression test, and an elevated plasma adrenocorticotropic hormone (ACTH), consistent with pituitary CD. As she was being prepared for surgical resection, she was noted to have spontaneous biochemical remission associated with resolution of her symptoms of hypercortisolism, and a repeat magnetic resonance imaging scan showed shrinkage of the sellar mass. She has been managed conservatively since and remains in clinical/biochemical remission until present time, 18 months following her initial presentation. Conclusion: We report a case of spontaneous resolution of CD from symptomatic hemorrhage within an ACTH-secreting pituitary adenoma, or PA. This has been rarely reported in the medical literature. The fact that she did not pass through a phase of adrenal withdrawal, makes us suspect a residual functional adenoma within or around the sella which may eventually grow, causing her disease to recur, as has been reported. Hence, continued monitoring will be required.

Repeat magnetic resonance imaging–guided focused ultrasound thalamotomy for recurrent essential tremor: case report and review of MRI findings

An 86-year-old right-handed man with medically refractory essential tremor was treated using left-sided MRI-guided focused ultrasound (MRgFUS) thalamotomy targeting the dentatorubrothalamic tract (DRTT) at its intersection with the ventral intermediate nucleus of the thalamus, with immediate symptomatic improvement and immediate postprocedure imaging demonstrating disruption of the DRTT. The patient experienced a partial return of symptoms 9 weeks following the procedure, and MRI demonstrated retraction of the left thalamic ablation site. The patient underwent repeat left-sided MRgFUS thalamotomy 4 months after initial treatment, resulting in reduced tremor. MR thermometry temperature measurements during the second MRgFUS procedure were unreliable with large fluctuations and false readings, likely due to susceptibility effects from the initial MRgFUS procedure. Final sonications were therefore monitored using the amount of energy delivered. The patient fared well after the second procedure and had sustained improvement in tremor control at the 12-month follow-up. This is the first report to describe the technical challenges of repeat MRgFUS with serial imaging.

Short-term Repeat Magnetic Resonance Imaging Scans in Suspected Early Axial Spondyloarthritis Are Clinically Relevant Only in HLA-B27–positive Male Subjects

Objective.Our study investigated the natural history of magnetic resonance imaging (MRI)–determined bone marrow edema over a 12-week period in individuals with suspected axial spondyloarthritis.Methods.There were 109 MRI scans performed on 30 patients who fulfilled the Assessment of Spondyloarthritis international Society inflammatory back pain criteria at baseline and at 4, 8, and 12 weeks.Results.There were 29 patients who completed the study. Only 4 (14%) patients changed from MRI-negative to MRI-positive (all HLA-B27–positive, OR 2.74). Three of 7 (43%) male HLA-B27–positive patients, 1 of 8 (12.5%) HLA-B27–positive female patients, and no HLA-B27–negative patients changed from MRI- negative to -positive.Conclusion.Repeat MRI scans within a 12-week period should be considered in HLA-B27–positive males.

The exploding tumour on breast magnetic resonance imaging: an infected skin comedo

A 61-year-old woman with a histologically proven invasive lobular carcinoma entered a clinical trial, which involved repeat magnetic resonance imaging (MRI). The protocol of the repeated MRI described a T4 breast cancer with involvement of the skin (Fig 1). There were only 17 days between the first and second MRI and during this short time it appeared that there had been rapid disease progression. On the initial MRI, a skin comedo could be seen in the left breast close to the tumour. The patient had squeezed the skin comedo, which had become infected. The second MRI captured the infected skin comedo, which had the appearance of an extensive breast cancer with skin involvement. The patient could be mismanaged if the clinician does not correlate the clinical findings with the radiological findings.