Microvascular proliferation in the clots: The key finding of acute subdural hematoma transforming into chronic subdural hematoma?

Background: Despite extensive investigations, the exact etiology of chronic subdural hematoma (CSDH) remains elusive. Organized CSDHs are a distinct but less-understood type of CSDH. Case Description: A 50-year-old hypertensive woman experienced headache without any previous head injury. At presentation, the patient showed no focal neurological deficits. Cranial computed tomography (CT) revealed a slightly compressive subdural hematoma that spontaneously regressed and no intracranial vascular lesions. Cerebral magnetic resonance imaging identified a non-enhancing nodular lesion in the subdural hematoma. After the patient presented disorientation and aphasia on post hospitalization day 14, CT showed a considerable enlargement of the subdural hematoma. Partial removal of the bi-layered hematoma was performed through a parietal craniotomy. Histological examination revealed microvascular proliferation in both the outer membrane and the nodular lesion. On postoperative day 35, CT demonstrated a remarkable resolution of the residual hematoma. Conclusion: Development of microvascular proliferation in the clots of an acute subdural hematoma may lead to its rapid enlargement as an organized CSDH. Organized CSDH can be managed by partial removal of the outer membrane and hematoma through a craniotomy.

Papillary Carcinoma: A Rare Cause Of Cutaneous Lesion on Dorsum of Nose

The skin of the nose is a common site for various benign and malignant lesions. Herein, we report a cutaneous nodular lesion on the dorsum of the nose in an 80-year-old female, which was surgically excised under local anesthesia. On histopathological examination, she was diagnosed with papillary carcinoma, a very rare disorder at such a location. The patient was followed-up and no recurrence was noted.

Intradural Intramedullary Capillary Hemangioma: A Case Report

Capillary hemangiomas are benign vascular tumors frequently reported when their location is in the skin or soft tissues. However, when the location is intradural and intramedullary, location becomes an extremely rare pathology. We present a 47-year-old male patient attended by the neurosurgery department of the Hospital General de la Plaza de la Salud, with an imaging finding of a nodular lesion at the level of T3 measuring 1.2 x 1.3 x 1.3 cm. During surgery, an exophytic lesion is evidenced by durotomy, very vascularized, whose anatomopathological and immunohistochemical report confirms the diagnosis of capillary hemangioma.

Safety and Efficacy of Vedolizumab in a Patient With Crohn's Disease After Developing An Active Tuberculosis Infection Associated With Infliximab-Biosimilar: A Case Report

Background: Screening of latent tuberculosis (TB) before the induction of anti-tumor necrosis factor (anti-TNF) agents is very important to prevent the reactivation of TB. However, active TB can still occur, and the ideal therapeutic strategy for IBD patients who develop active TB has not been established. Case presentation: A 21-year-old Vietnamese man with active ileo-colonic Crohn’s disease visited our hospital. While computed tomography (CT) revealed a nodular lesion at the right lung, a serological interferon gamma release assay (IGRA) and several culture tests were all negative. The intravenous administration of infliximab-biosimilar (IFX-BS) with an immunomodulator were initiated. After the induction therapy, he achieved clinical remission. However, he presented with a high fever 17 weeks after the initiation. CT revealed the expansion of the nodular lesion at the right lung, and serological IGRA was positive. He was diagnosed with reactivation of latent TB. He had not achieved mucosal healing when immunosuppressive therapy was discontinued. Thus, he was administered vedolizumab (VDZ), which was considered not to influence the TB status, as maintenance therapy. Consequently, he achieved mucosal healing without relapse of active TB.Conclusions: This is the first report to describe the safe usage of VDZ as maintenance therapy without the induction of TB relapse in a CD patient. In Asian countries, clinicians must be alert for the reactivation of latent TB during the administration of anti-TNF agents. VDZ might be a safe option for maintenance therapy in CD patients, even in cases with active TB.

Sciatic schwannoma: rare case report

Introduction: Schwannoma is the most common benign tumor of the peripheral nerve sheath. They appear in the sheath of the nervous fascicle and are well-defined masses, which allow their dissection of the underlying neural bundle. Sciatic nerve involvement is rare, accounting for less than 1%. Case report: Male, 83. He has had sciatica on the left for 10 months. With progression of pain, VAS of 9 and difficulty to walk for 1 month after admission. On physical examination, a positive tinel sign in the left gluteal region with tactile perception of nodular lesion in sciatic nerve topography. Preserved and discrete hypoesthesia strength in left sciatic nerve territory. MRI shows nodular lesion, suggestive of neural sheath tumor. Undergoing a surgical procedure for excision of the lesion. Total resection of the lesion was performed with no changes in monitoring potential. The patient was discharged from the hospital the next day, with a VAS of 0, with no other complaints and pain control. Discussion: Schwannomas have a long subclinical course, their clinical presentation is usually misleading. The referred patient started with sciatica, with painful progression to VAS 9. The diagnoses of sciatic nerve schwannomas are made with MRI. The definitive diagnosis is possible after the histopathological study. The treatment of this tumor is by massive excision and preservation of the nerve. Conclusion: Studies regarding sciatic nerve Schwannoma are scarce. There is a need for further studies on the case, to train health professionals to recognize and effectively treat the pathology.

AYURVEDIC MANAGEMENT OF VISPHOTAKA: A CASE STUDY

Visphotak is characterized with Agnidagdhanibha (Burning sensation feels like burned by fire), Sphota (white or red color nodular lesion along with clear fluid), Swajwara (persisting fever) which spreads all over the body all over the body. A six years old male, came into the OPD of Syamadas Vaidya Shastra Pith Hospital at Kolkata, presenting with complaints of generalized Blisters (vesicle) over the body associated with Osha (burning sensation all over the body), Arti (pain), mild fever, Kandu and oozing since last three months. Karma or treatment depends on Dosaswabhava. After treatment, vesicles were completely resolved with no sign of relapse and some scar marks. Photographs were taken before and after completing treatment of 3 months only after getting the patients consent. The outcome was a combined effect of both Shaman-sodhan and Ropana (through Prakshalan) therapy along with Pathya sevan. Hence, it was concluded that application of treatment principle of Pittaja Visarpa was justified in Visphotaka.