Superficial temporal artery pseudoaneurysm as cause of refractory headache

Case presentation: A 36-year-old male presented with moderate, progressive headache, in the left temporal region, irradiating to the ipsilateral frontal region, with several months of evolution, refractory to analgesic medication, including opioids. He reported a closed traumatic brain injury (TBI) 5 years before in a motorcycle collision with an automobile, without a helmet. At the physical examination, it was possible to verify a pulsatile mass measuring 1.5 cm in diameter, with fremitus, in the left temporal region. The magnetic resonance imaging scan presented a round lesion, encapsulated, on the course of the superficial temporal artery (STA). The digital subtraction angiography confirmed the diagnosis of STA pseudoaneurysm. A surgical resection of the aneurysm was performed, leading to the complete resolution of the headache. Discussion: The STA pseudoaneurysm is a rare condition, representing less than 1% of aneurysms, usually presenting as a late complication of TBI. The majority of cases are asymptomatic, although focal symptoms and even bleeding may occur. The presentation with a chronic refractory headache is exceptional. Its treatment is indicated for local symptom resolution, aesthetic purposes, and rupture prevention, done by clipping and resection of the pseudoaneurysm. Conclusion: Even though unusual, the awareness of this condition is important for the etiological diagnosis of a persistent temporal headache in a patient with a history of TBI.

Dirofilariasis in humans presenting as a subcutaneous nodule

Human dirofilariasis is an uncommon zoonotic roundworm infection caused by worms belonging to dirofilaria species transmitted by zoo -anthropophilic blood sucking insects which is known to manifest as ocular infection or as a subcutaneous nodule usually in the upper part of the body. We present a case report of subcutaneous dirofilariasis in the left temporal region besides the eye brow in a 65yr old female, clinically diagnosed as epidermal cyst. Gross and histopathological evaluation revealed the presence of an adult worm with granulomatous inflammatory reaction.

Coexisting arachnoid cyst and tentorial sinus: A therapeutic dilemma

A 4-year-old male presented with a large arachnoid cyst over the left temporal region causing displacement of adjacent structures. Cerebral angiography showed dilatation of the tentorial sinus without other apparent vascular alterations. The association of these two anomalies raises a therapeutic dilemma as no information is available about how the variants of the venous system can modify cerebrospinal fluid hydrodynamics and thus affect arachnoid cyst’s prognosis. In this case, the patient was treated conservatively and has remained stable for 2 years.

Reduced Temporal Activation During a Verbal Fluency Task is Associated with Poor Motor Speed in Patients with Major Depressive Disorder

Objective Substantial research has revealed cognitive function impairments in patients with major depressive disorder (MDD). However, the relationship between MDD cognitive function impairment and brain activity is yet to be elucidated. This study aimed to reveal this relationship using near-infrared spectroscopy (NIRS) to extensively measure frontotemporal cortex function.Methods We recruited 18 inpatients with MDD and 22 healthy controls. Regional oxygenated hemoglobin changes (oxy-Hb) were measured during a verbal fluency task and its relationship to cognitive function was assessed. Cognitive function was assessed using the Japanese version of the Brief Assessment of Cognition in Schizophrenia.Results Compared to healthy controls, patients with MDD displayed poorer motor speed, attention and speed of information processing, and executive function. In the bilateral prefrontal and temporal surface regions, regional oxy-Hb changes were significantly lower in patients with MDD than in healthy individuals. Moreover, we observed a correlation between reduced activation in the left temporal region and poor motor speed in patients with MDD.Conclusion We suggest that reduced activation in the left temporal region in patients with MDD could be a biomarker of poor motor speed. Additionally, NIRS may be useful as a noninvasive, clinical measurement tool for assessing motor speed in these patients.

Camel Bite Associated with Depressed Skull Fracture with Rapidly Spreading Subgaleal Cellulitis

Camel bite represents a minimal proportion, and most of them are from the Middle East countries. Their infectious potential is poorly understood, and the guidelines for antimicrobial treatment are not well developed. We describe a 40-year-old male, who works as a camel herder and was bitten by a camel while he was tying it down which led to a unilateral depressed skull fracture and multiple bilateral teeth-puncture wounds in the scalp. He arrived to our emergency department 3 hours after injury. All the wounds were dry and the skin around them was healthy looking with no subcutaneous collections. CT scan of the head showed depressed skull fracture on the left temporal region. Within 12 hours, the patient developed spreading cellulitis in the scalp. This necessitated an urgent surgical intervention. The added challenge is the presence of a dural breach. Our patient presented a challenge at several levels. He presented early with clean puncture wounds that were treated according to the most agreed upon guidelines. But our novel finding of rapidly spreading cellulitis requires alteration of recommendation towards more aggressive therapeutic attitude including early surgical intervention, especially for those patients suspected of a dural tear with the depressed skull fracture, even if treated with appropriate antibiotics.

Isolated unilateral temporalis muscle hypertrophy: first case in an Indo-Aryan

Unilateral hypertrophy of temporalis muscle (isolated type) is extremely rare and only 14 cases have been reported in English literature since 1990. Although no definitive etiology is identified, stress and bruxism are among the many factors are linked to it. Reported patient ages ranged from 7 years to 62 years and most of them are Caucasians. Here we report the first ever case of an Indo-Aryan ethnic patient who presented with painful swelling of the left temporal region. Temporalis muscle biopsy confirmed the diagnosis of isolated unilateral temporalis muscle hypertrophy. This case raises the importance of considering rare diagnoses such as isolated unilateral temporalis muscle hypertrophy despite the inadequate statistical data on ethnicity or geographic location of a condition.

Metastatic renal cell carcinoma in the head and neck region

<p>We describe 3 rare cases of metastatic renal cell carcinoma in the head and neck region. Our first case was a 72 years old male presented with profuse bleeding from the left ear. On examination, proliferative, pink, friable mass was present in the left external auditory canal. On eliciting the detailed history, it was found that patient had renal cell carcinoma in the left kidney four years back and underwent left radical nephrectomy. Patient underwent left lateral temporal bone resection with cul-de-sac closure. Histopathological examination of the specimen showed metastatic renal cell carcinoma. Our second case was a 64 years old male presented with complaints of growth in the oral cavity of 1 month duration. On examination, 5×3 cms proliferative growth was present in the hard palate. Biopsy from the growth in the hard palate showed metastatic renal cell carcinoma. Patient gave history of renal cell carcinoma in the past for which he did not receive treatment. Our third case was a 45 years old male who presented to us with a diffuse swelling in the left temporal region of 2 months duration. On examination, 3×2 cms swelling was present in the left temporal region. Patient had history of renal cell carcinoma of left kidney and underwent left nephrectomy one year prior to the presentation of the left temporal swelling. Ultrasonography guided biopsy of the left temporal region showed metastatic renal cell carcinoma.</p>