The fate of a Military Pilot in Malaysia: Lingering on the ground after young stroke

Strokes in young pilots can result in the devastating loss of productive years of life, especially for pilots at the peak of their careers. A 32-yr-old male military helicopter pilot was diagnosed with superior sagittal sinus thrombosis and bilateral parietal hemorrhages secondary to protein S deficiency after 15 years in military service. Two years post-stroke, he was carefully evaluated for a possible return to work after aeromedical assessment and the 1 percent rule being considered. A decision was made by the medical board for him to be disqualified to fly and grounded with work accommodation. The authors recommend that there is a need for reassessment up to two years using the objective PULHEEMS method for young pilots who failed aeromedical assessment due to stroke for returning to work as their experiences and knowledge is highly valuable.

COVID 19 & Mucormycosis- The Mystery of Intertwined Pathologies

An anesthesiologist has been constantly pushed from the domains of being a perioperative physician to that of a COVID physician in the current COVID -19 pandemic. We have been sailing uncharted water pressured to unearth the mysteries of COVID 19 for 18 months now without any definitive treatment. Come April 2021, mucormycosis had become the talk of the town! India saw an exponential rise in cases of post covid mucormycosis. Ample theories and speculations were dug out to understand if there is a causal relationship at all. The fact is mucormycosis cases did exist in the pre-covid era as well but what led to its sudden skyrocketing numbers in covid times needed some brainstorming and hence prompted me to pen this piece of write up. Dr Poonam Ghodki, Professor of Anaesthesiology in SKNMC & GH, Pune has kindly shared some brilliant inputs from her experience of managing these challenging cases on various platforms through Anaesthesiatv. She quotes that the commonly used term black fungus is a misnomer as the black fungus is a yeast with abundant melanin on the surface. Mucormycosis is a different fungal pathology that gets its characteristic appearance due to the devitalisation of affected tissues. Although ubiquitous, human beings are resistant to its deadly invasion. Under favourable circumstances, the opportunistic fungus after angioinvasion causes ischaemia and necrosis of contagious tissue forming the hallmark blackish eschar [1]. The five main types of mucormycosis described are rhino-orbitocerebral, pulmonary, cutaneous, gastrointestinal and disseminated, of which rhino-orbitocerebral has been observed to be the commonest. In the rhino-orbitocerebral variant, the fungus invades the lamina papyracea of ethmoidal sinuses and gains access to orbit leading to proptosis and blindness. It could gain entry through the cribriform plate to the brain and cause sagittal sinus thrombosis and stroke. Gaining further clarity on managing Covid 19 cases recovery increased man

Superior sagittal sinus thrombosis as a focal point of pulmonary embolism

This article represents the discussion of a clinical case of superior sagittal sinus thrombosis as a focal point of fatal pulmonary embolism. Pulmonary embolism is a life-threatening condition, with a mortality rate of up to 40%. The direct source of pulmonary embolism is deep vein thrombosis of the lower extremities and pelvis in 80–90% of all cases. The veins of the upper extremities and venous heart cause it less often. Pulmonary embolism in patients with cerebral venous thrombosis is observed in 1.4% of patients.Cerebral venous thrombosis is a cerebrovascular disease manifested by venous outflow disorders due to acute occlusion of the sinuses and veins of the brain. It requires immediate treatment in order to prevent the development of intracranial hemorrhage, venous infarction, disability and death. Cerebral venous thrombosis accounts for approximately 0.5% of all cases of cerebrovascular disease worldwide. In contrast to ischemic stroke, cerebral venous thrombosis is more common in younger patients. Currently, the diagnosis of cerebral venous thrombosis is based on neuroimaging data, and timely treatment leads to a decrease in disability and mortality.

Superior sagittal sinus thrombosis in childhood – a case report

Cerebral venous sinus thrombosis (CVST) is presence of a blood clot in the dural venous sinuses. This is a rare, but dangerous condition. CSVT is characterized by a highly variable clinical spectrum, difficult diagnosis, variable etiologies and prognosis. The International Study on Cerebral Vein and Dural Sinus Thrombosis (ISCVT) determined the frequency of the sites of SCVT. The aim of this case study was to show the clinical presentation, the examination we made, the therapy that was ordinated and the outcome of the treatment. Case study: A 14-year-old male teenager was admitted to the University Clinic for Neurosurgery in Skopje with GCS 10, accompanied with tonic-clonic epileptic seizures. CT examinations by systems were made, and during the time of recording the patient was given Dormicum 2mg overall dose. CT scan of the brain showed hyperdense zones formation around superior sagittal sinus (SSS), the rest of the medical finding was normal. We ran laboratorytests and the test for hemostasisshowed deviation from the normal range. With the ordinated therapy the clinical condition of the patient drastically improved. He was discharged home 12 days after the admission. He was given a recommendation for further check-ups by a transfusiologist and regular visits to our clinic. Occlusion of the cerebral veins and dural venous sinuses may occur on the basis of local trauma, neoplasm or infection. Primary aseptic thrombosis may involve either cerebral veins or dural venous sinuses, or both in combination. The clinical picture and the prognosis of intracranial venous thrombosis probably depend largely on the location, extent, and rapidity of development of the venous occlusion. Conclusion: Superior sagittal sinus thrombosis is a condition that can be manifested with diverse and many symptoms and signs, which often can start unexpectedly and can be life-threatening.