Low-dose Propofol for the Treatment of Severe Postpartum Post-dural Puncture Headache: A Case Report

In this report, we presented our experience in treating severe postpartum post-dural puncture headache with low-dose propofol. Short-term use of low-dose propofol provided rapid and complete relief of the headache without recurrence.

Bleeding Milky Way!

Many people regard herbal plants as a safe natural product and routinely consume them for maintenance of healthy life or as home remedies without considering their potential health-threatening side effects. Here, we presented manifestations of milk thistle toxicity. The milk thistle’s flavonolignans, especially the silybin ingredient disturb the hemostatic process by dual anticoagulant and anti-platelet properties. This plant can inhibit serine proteases, including factors II and X as in the coagulation cascade as well as platelet activation by blocking adenosine diphosphate receptor and cyclooxygenase; hence, it causes bleeding diathesis.

Essential Thrombocythemia Following Immune thrombocytopenia With JAK2 V617F Mutation: A Case Report

Immune Thrombocytopenia (ITP) is an autoimmune bleeding disorder. Tyrosine Kinase JAK2 (JAK2 V617F) mutation occurs in nearly 60% of Essential Thrombocythemia (ET) patients. Both diseases produce impaired platelet. We describe a case with ET following ITP. So far, only 3 reports described ET following ITP. We report the fourth patient with JAK2 V617F mutation at the onset of ITP presented 20 years ago that needed splenectomy. The association of these two diseases may recommend similar pathogenic mechanisms between Myeloproliferative Neoplasms (MPNs) and ITP that should be further explored.

Retroperitoneal Angiomyolipoma in A Woman of Childbearing Age: A Case Report

Introduction: Extrarenal angiomyolipoma is an uncommon disease entity and is rare in the retroperitoneum. This lesion shows three benign components, including mature adipose tissue, thick-walled blood vessels, and smooth muscles. Case Report: This report describes a 37-year-old woman who presented with incidental right retroperitoneal mass in prenatal checkup. The patient underwent excisional surgery. Histological examinations and the immunohistochemical study revealed angiomyolipoma. Based on the diagnosis, the patient received no more treatment. After 3 years of close followup examinations, no recurrence was observed. Conclusion: This diagnosis is often confused with many other entities in retroperitoneum. Thus, imaging and histologic correlation are required. Proper diagnosis is essential for further patient management and avoids unnecessary treatment.

A Patient With Optic Nerve Pit Maculopathy Successfully Treated With Juxtapapillary Laser Photocoagulation

Optic disc pits are rare and congenital or acquired anomalies of the optic disc, usually remaining asymptomatic. However, serous macular detachment or optic disc maculopathy is the most common complication, causing significant visual deterioration, without a current consensus about treatment. A 55-year-old woman with a past medical history of diabetes mellitus and systemic hypertension was referred for an abnormal finding in the retina. The Corrected Distance Visual Acuity (CDVA) was 20/40 in the right eye and 20/30 in the left eye. Marcus-Gunn was negative and Slit-lamp biomicroscopy revealed no pathologic findings in both eyes. Funduscopic examination showed an excavation in the inferotemporal part of the Optic Nerve Head (ONH) with serous macular detachment extending to the optic disc. Based on clinical examination and paraclinical imaging fluorescein Angiogeraphy (FAG) Optical Coherence Tomography (OCT), optic pit maculopathy was diagnosed and the patient underwent Juxtapapillary Laser Photocoagulation (JLP). After 2 years of follow-up, there were anatomical and functional improvements.

Extramedullary Hematopoiesis Presenting as Progressive Headache: A Case Report and Review of Literature

Extramedullary Hematopoiesis (EMH) is defined as the production of blood cells in organs other than bone marrow. Intracranial EMH is a rare condition. In this article, we presented a case of intracranial EMH presenting as progressive headache. Our patient was a 33-yearold man with thalassemia presenting with acute progressive flaccid quadriplegia, severe progressive headache, and decreased level of consciousness. His imaging studies showed evidence of intracranial and presacral EMH. Most asymptomatic intracranial EMH can present as a variety of symptoms, including progressive headache; therefore, the differential diagnosis should be kept in mind when evaluating a patient with a relevant underlying medical condition.

Pitfalls in the Histopathologic Diagnosis of Meningioma: Report of Three Rare Variants of Meningioma and Literature Review

Meningioma is a common primary tumor of the central nervous system and one of the most encountered brain tumors. Although classic histopathologic features of meningioma are relatively common and make its diagnosis straightforward, certain variants possess unusual histologic features causing diagnostic challenges. We reported three cases of clear cell meningioma, microcytic meningioma, and angiomatous meningioma report, variants with potential deceptive morphologies, and discuss their distinguishing morphologic features.

Management of Two Unusual Patients With Vascular Anomalies

Vascular anomalies form a significant portion of congenital defects and venous malformations are the most prevalent type among adults. Multiple imaging modalities have been proposed for pre-operation assessments. Although some studies have reported Magnetic Resonance Imaging (MRI) as the most valuable modality, in many situations, CT scan remains the equipment of choice due to its availability. In each case, a precise assessment of the malformation is needed. In two cases mentioned in our study, prior to the operations, only a monophasic CT scan was performed that resulted in missing evidence of severity and extent of venous malformation. One of the imaging procedures is a three-phase CT scan. Although in the monophasic CT scans, a delay of 65 seconds is applied, in three-phase CT, both filling in and washing out are notable, which gives three-phase CT a more predictive value about flow pattern over monophasic CT.

Acute Hemolytic Anemia Induced by Levofloxacin in A Woman With G6PD Deficiency: A Case Report

Introduction: Glucose 6-Phosphate Dehydrogenase deficiency (G6PD) is an X-linked recessive disorder recognized as the most prevalent enzyme deficiency around the world. G6PD deficiency has a high prevalence in Iran, especially in the northern regions. As we know, hemolysis in G6PD patients was not reported with levofloxacin previously. Case Report: In this report, we introduce a 54-year-old G6PD deficient woman who experienced the symptoms of hemolytic anemia following completion of treatment with levofloxacin. Result: After ruling out other causes of hemolysis, by using the Naranjo scale, levofloxacin was considered as a possible cause of hemolysis. Conclusion: Though the hemolytic anemia induced by levofloxacin is extremely rare in G6PD deficient patients, drug-induced hemolytic anemia should be considered as one of the differential diagnoses. It would be appropriate to use an alternative antibiotic instead of levofloxacin in a G6PD deficient patient.

Bilateral Testicular Torsion: A Case Report

Bilateral testicular torsion is a rare condition. We report a case of a male newborn with bilateral enlarged and firm testes. Color-Doppler revealed no evidence of vascular flow in both testes. Although intraoperative findings were in favor of bilateral infarcted and gangrenous testes, the patient underwent bilateral orchiopexy after conferring with his parents. At sixmonth follow-up, both testicles were atrophic. Management of bilateral neonatal testicular torsion is controversial and includes conservative management, orchiopexy, and orchiectomy. The possibility of salvaging testis in neonatal testicular torsion is very low in each treatment modality.