Spontaneous Intracerebral Hemorrhage (ICH) associated with pregnancy and SARS-CoV-2 infection: a case report

Background Coronavirus Disease 2019 (COVID-19) is predominately known as a respiratory disease associated with pneumonia, acute respiratory distress syndrome and multiorgan failure. However, extra-pulmonary complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly being recognized. In this regard, some studies implied the hemostatic and vascular involvements in patients with SARS-CoV-2 infection. Case presentation We describe a case of spontaneous Intracerebral Hemorrhage (ICH) in a pregnant patient with COVID-19 and history of cesarean section a week before the occurrence of ICH. The patient underwent emergent craniotomy with acceptable outcome. Hemorrhagic events, including ICH, may happen during COVID-19 infection with several possible mechanisms. Conclusion COVID-19 patients, especially high-risk groups, are at a risk of intracranial hemorrhage. Therefore, close follow-up must be maintained and hemorrhagic events must be kept in mind in these cases.

Rethinking individual autonomy in medical decision-making for young adults reliant on caregiver support: A case report and analysis

There is a gap in the clinical bioethics literature concerning the approach to assessment of medical decision-making capacity of adolescents or young adults who demonstrate diminished maturity due to longstanding reliance on caregiver support, despite having reached the age of majority. This paper attempts to address this question via the examination of a particular case involving assessment of the decision-making capacity of a young adult pregnant patient who also had a physically disabling neurological condition. Drawing on concepts from adolescent bioethics and feminist critiques of bioethical theory, we argue that limited life experience, secondary to a disabling neurological condition, can result in a lack of adult-like capacity even in a patient who is legally an adult. In such cases, it may be that autonomy, to the extent that it is to be relevant and meaningful, must be viewed through a relational lens. Furthermore, clinicians may avoid unjustifiably paternalistic practices by working with the patient help her gain a better appreciation of the consequences of her decision, thereby calling forward her capacity rather than resorting to being directive in counseling. We conclude that lessons from this case can be used to approach ethically complex instances of medical decision-making in adult patients with normal cognition but diminished experiential maturity.

A rare case of ovarian torsion in a pregnant patient

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. It is an uncommon cause of acute abdominal pain in females, and it is a gynecologic emergency. The majority of the cases present in the pregnant (22.7%) than in non-pregnant (6.1%) women. Diagnostic delay can result in loss of the ovary. This twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is also compromised, leading to ischemia and infarction. The increased use of ovarian stimulation and assisted reproductive technology has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). The differential diagnosis of adnexal torsion is particularly difficult in combination with OHSS or pregnancy, as abdominal pain, nausea and vomiting can be presenting symptoms of hyperstimulation or pregnancy as well. Here, we report a case of ovarian torsion occurring in pregnancy in which diagnostic delay occurred due to confusion with OHSS leading to oophorectomy. Fertility conservation may have been possible in case of earlier diagnosis and prompt treatment.

An Uncommon Recurrent Metastasis of Ovarian Immature Teratoma to the Small Bowel

Immature ovarian teratomas are rare ovarian germ cell tumors associated with a variable potential of distant metastasis. The acquisition of mature phenotypes upon post-treatment recurrence of immature teratomas has been previously described. In this study, we report, for the first time, a rare case of a recurrent ovarian immature teratoma with mature deposits in the small bowel. An incidental pelvi-abdominal mass was identified in a 30-year-old pregnant patient during antenatal ultrasonography. The mass, which was resected through salpingo-oopherectomy, was histopathologically characterized as an immature teratoma of grade 2 and treated with 3 cycles of chemotherapy. After 3 years of completing treatment, the patient suffered from severe anemia which was investigated by capsule endoscopy that identified a bleeding source in the ileum. Imaging studies revealed an intrabdominal mass that was resected laparoscopically. The pathological assessment of the mass identified a submucosal/intramuscular teratoma with mature elements indicative of a recurrent metastasis of immature teratoma associated with post-chemotherapy retroconversion. The secondary mass was then managed with adjuvant chemotherapy.

Hydranencephaly: A rare case report

Hydranencephaly (HE) is a rare condition occurring in <1/10,000 births worldwide. It is one of the recognized forms of brain malformations that are usually associated with intrauterine fetal demise rarely seen in postnatal life. HE can often be misdiagnosed due to certain common features with other neurological abnormalities such as hydrocephalus, holoprosencephaly, and porencephaly. Here, we report the case of a 26-year-old pregnant patient at 34 weeks who was referred with ultrasonography finding of HE which was confirmed by fetal MRI. The decision to deliver the baby was taken expecting an extremely poor outcome after discussing with the family.