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1
Teasell, Robert. "Musculoskeletal complications of hemiplegia following stroke." Seminars in Arthritis and Rheumatism 20, no. 6 (June 1991): 385–95. http://dx.doi.org/10.1016/0049-0172(91)90014-q.
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D'Ascanio, L., L. Cappiello, and F. Piazza. "Unilateral hemiplegia: a unique complication of septoplasty." Journal of Laryngology & Otology 127, no. 8 (July 9, 2013): 809–10. http://dx.doi.org/10.1017/s0022215113001436.
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AbstractBackground:Septoplasty is one of the most common otolaryngological operations. It is often dismissed as a simple procedure, despite the wide range of potential complications. We describe the first reported case of unilateral hemiplegia as a complication of septoplasty.Methods and results:A 51-year-old man presented with right hemiplegia following a septoplasty and turbinoplasty procedure carried out elsewhere. Cranial imaging showed a breakthrough fracture of the left sphenoid sinus anterior wall and clivus, with a haemorrhagic area in the left paramedian pons, which was responsible for the patient's right hemiplegia. Despite neurological and physiotherapeutic rehabilitation, the patient gained only partial recovery from his right hemiplegia.Conclusion:Good intra-operative visualisation and appropriate surgical technique are essential to prevent complications and achieve a functional nasal airway. The importance of the presented case to the pre-operative informed consent process is underlined.
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Suda, Kenji, Masahiko Matsumura, and Shigeru Ohta. "Kawasaki disease complicated by cerebral infarction." Cardiology in the Young 13, no. 1 (February 2003): 103–5. http://dx.doi.org/10.1017/s1047951103000179.
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An 8-month-old boy presented with right hemiplegia of sudden onset after 20 days of Kawasaki disease, which was not initially treated by gamma globulin. Cranial X-ray computed tomography confirmed cerebral infarction as the cause of the right hemiplegia. In subsequent weeks, he developed multiple thromboses in coronary aneurysms. He successfully underwent intracoronary thrombolysis using tissue plasminogen activator without haemorrhagic complications. Cerebral infarction as a complication of Kawasaki disease is rare, and is a difficult clinical situation to manage.
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Kakurai, S., and M. Akai. "Clinical experiences with a convertible thermoplastic knee-ankle-foot orthosis for post-stroke hemiplegic patients." Prosthetics and Orthotics International 20, no. 3 (December 1996): 191–94. http://dx.doi.org/10.3109/03093649609164442.
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As rehabilitation for post-stroke hemiplegic patients has become widely accepted practice, there has been an increase in patients who are more difficult to treat. In the prescription rationale of orthoses for hemiplegics, the knee-ankle-foot orthosis (KAFO) for the lower limb has generally been underestimated because of its inhibitory effect on the normal walking pattern and also its interference with gait training. The authors had an experience of 28 hemiplegics with severe physical impairments who were fitted with a convertible plastic KAFO. Among these patients, there were 11 cases in which the KAFO was replaced by an ankle-foot orthosis (AFO) within 1.5 to 8 months (average 4 months) following initial prescription when they were able to control their knee actively. Ambulatory capability in these patients was superior to that of the remaining KAFO group. The Barthel index of the AFO group patients was higher than the KAFO group (p<0.01). However neither age, sex, severity of hemiplegia, starting time of rehabilitation following onset of stroke, time of fitting with the orthosis, nor the functional recovery stage were critical factors between the two groups, only the incidence of major complications affected ambulatory capability.
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Brinjikji, Waleed, and Harry J. Cloft. "Outcomes of endovascular occlusion and stenting in the treatment of carotid blowout." Interventional Neuroradiology 21, no. 4 (June 18, 2015): 543–47. http://dx.doi.org/10.1177/1591019915590078.
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Background and purpose Carotid blowout is a life threatening complication of invasive head and neck cancers and their treatments. This is commonly treated with endovascular embolization and carotid stenting. Using the Nationwide Inpatient Sample, we report the immediate clinical results of patients receiving embolization and/or stenting for treatment of carotid blowout associated with head and neck cancer. Materials and methods Using the Nationwide Inpatient Sample from the period 2003–2011, we defined carotid blowout patients as those with head and neck malignancies receiving carotid stenting and/or endovascular embolization without open surgery. Outcomes studied included mortality, acute ischemic stroke, hemiplegia/paresis, and other post-operative neurologic complications. Outcomes for the endovascular embolization and carotid stenting group were compared. Results A total of 1218 patients underwent endovascular treatment for carotid blowout. Of these, 1080 patients (88.6%) underwent embolization procedures and 138 patients (11.4%) underwent carotid stenting. The mortality rate of endovascular embolization patients was similar to that of carotid stenting patients (8.0%, 95% confidence interval (CI) = 6.5%–9.7% versus 10.2%, 95% CI=6.0%–16.4%, p = 0.36). Stroke rate was similar between embolization patients and stenting patients (2.3%, 95% CI=1.6%–3.4% vs. 3.4%, 95% CI=1.3%–8.4%, p = 0.43). Hemiplegia rates were significantly higher rate in stenting patients compared with endovascular occlusion patients (3.8%, 95% CI=1.3%–8.4% vs. 1.4%, 95% CI=1.4%–2.4%, p = 0.05). The rate of post-operative neurologic complications was higher in stenting patients compared with embolization patients (6.5%, 95% CI=3.3%–12.1% vs. 1.4%, 95% CI=0.9%–2.4%, p < 0.0001). Conclusions Given the natural history of carotid blowout, carotid stenting and endovascular embolization are acceptable means of treating this disease. Endovascular embolization remains the most common treatment among patients with head and neck cancers with lower overall rates of post-operative neurologic complications, including hemiplegia/paresis and stroke.
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De Clercq, E., F. Rossignol, and A. Martens. "Laryngeal hemiplegia in the horse: an update." Vlaams Diergeneeskundig Tijdschrift 87, no. 5 (October 31, 2018): 283–94. http://dx.doi.org/10.21825/vdt.v87i5.16062.
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Laryngeal hemiplegia is a progressive upper airway dysfunction in the horse. It is not only seen in thoroughbred racehorses but also in warmblood horses, draft horses and in ponies. The condition is most frequently seen on the left side. The left laryngeal recurrent nerve gradually loses function and the function of the left cricoarythenoideus dorsalis muscle is compromised. This condition is most often idiopathic. It possibly leads to exercise intolerance but a respiratory noise is often the primary complaint of the owner. Right sided laryngeal hemiplegia is almost always related to other pathologies causing the nerve to malfunction. The diagnosis is not always easy because of the restricted availability of endoscopy in the field. A better understanding of laryngeal ultrasound examination might offer a new possibility in diagnosing laryngeal hemiplegia. If abnormal inspiratory sound is the only problem, laser treatment alone can be satisfactory. If the horse shows clear signs of exercise intolerance, further treatment is needed. If correctly executed, the outcome of laryngoplasty is good. Other techniques, like nerve grafting and pacemakers, are being explored and might even be regarded as better alternative treatments in the future, as these are more physiologic compared to laryngoplasty. In sporthorses presented with idiopathic laryngeal neuropathy without postoperative complications, the prognosis is good.
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Song, Donglei, Bing Leng, Yuxiang Gu, Wei Zhu, Bin Xu, Xiecheng Chen, and Liangfu Zhou. "Clinical Analysis of 50 Cases of BAVM Embolization with Onyx, a Novel Liquid Embolic Agent." Interventional Neuroradiology 11, no. 1_suppl (October 2005): 179–84. http://dx.doi.org/10.1177/15910199050110s122.
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To report the embolization technique of using Onyx, a new liquid embolic agent, to treat cerebral arteriovenous malformations (AVMs) as well as its efficacy. 38 cases of cerebral AVMs located in eloquent area (motor, speech, visual nerve center), 9 in deep cerebral area, and another 3 cases in cerebellar hemisphere. The diameter of AVMs was smaller than 3cm in 10 cases, 3–6cm in 30 cases, and larger than 6cm in 10 cases. A 6F sheath was placed into the femoral artery after Selding's puncture. After a 6F guiding catheter was introduced into the internal carotid artery or vertebral artery, Ultraflow or Marathon microcatheter could be navigated into the nidus of AVMs. A long-slow injection of Onyx under fluoroscopic control was performed to embolize cerebral AVMs by adopting the “plug and push” technique. 10 AVM cases (20.0%) were considered to be totally occluded with Onyx in this group, 3 cases of which were found no regrowth by a 6-month follow-up. 25 cases (50%) were subtotally occluded while another 15 cases (30%) were partially embolized. Complications include: (1) severe cerebral hemorrhage occurred in three cases, two of them left hemiplegia after hematoma resection. (2) mild hemiplegia occurred in one lager frontal AVM patient. (3) mild visual deficit was left in one larger occipital AVM case. There was no severe complication in other 45 patients. Onyx has unique and distinctive superiority in treating cerebral AVMs. Nonetheless, the correct embolization technique should be learned to achieve good clinical results and to avoid complications. The long-term efficacy of Onyx embolization needs to be followed up.
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Linskey, Mark E., Laligam N. Sekhar, and Stephen T. Hecht. "Emergency embolectomy for embolic occlusion of the middle cerebral artery after internal carotid artery balloon test occlusion." Journal of Neurosurgery 77, no. 1 (July 1992): 134–38. http://dx.doi.org/10.3171/jns.1992.77.1.0134.
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✓ Balloon test occlusion of the internal carotid artery (ICA) is useful in preoperatively assessing the risk of temporary occlusion or permanent sacrifice of the carotid artery. The incidence of symptomatic complications from this procedure is 1.7%. The case is reported of a 57-year-old woman in whom a balloon test occlusion of the left ICA was attempted. She developed a left ICA dissection/occlusion with subsequent embolization to the left middle cerebral artery, leading to right-sided hemiplegia and expressive aphasia. She was successfully treated by an emergency embolectomy followed by surgical repair of the left ICA, with an excellent outcome. This case represents the most serious complication encountered by the authors in more than 300 balloon test occlusions. Means of avoiding this complication during balloon test occlusion as well as the important factors in managing this problem are emphasized.
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Ochi, Fumihiro, Hisamichi Tauchi, Toyohisa Miyata, Tomozo Moritani, Toshiyuki Chisaka, Junpei Hamada, Kozo Nagai, Minenori Eguchi-Ishimae, and Mariko Eguchi. "Brain Abscess Associated with Polymicrobial Infection after Intraoral Laceration: A Pediatric Case Report." Case Reports in Pediatrics 2020 (March 9, 2020): 1–5. http://dx.doi.org/10.1155/2020/8304302.
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Brain abscesses, infections within the brain parenchyma, can arise as complications of various conditions including infections, trauma, and surgery. However, brain abscesses due to polymicrobial organisms have rarely been reported in children. We herein report a case of a 9-year-old girl with unresolved congenital cyanotic heart disease (CCHD) presenting with right hemiplegia who was diagnosed with brain abscess caused by Streptococcus intermedius, Parvimonas micra, and Fusobacterium nucleatum after oropharyngeal injury. She was treated with intravenous antimicrobial therapy, drainage under craniotomy, and antiedema therapy with glycerol and goreisan, which led to the improvement of right hemiplegia to baseline; she was discharged following eight weeks of intravenous antimicrobial therapy. The clinical diagnosis of the brain abscess was difficult due to the nonspecific presentation, highlighting the importance of cranial imaging without haste in patients at increased risk for brain abscesses such as those with CCHD, presenting with fever in the absence of localizing symptoms or fever, accompanied with abnormal neurological findings.
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Shokeen, Priyanka, Suman Yadav, Chaman Ram Verma, and Rupesh Masand. "Neurological complications in Dengue fever." International Journal of Contemporary Pediatrics 5, no. 3 (April 20, 2018): 983. http://dx.doi.org/10.18203/2349-3291.ijcp20181526.
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Background: Neurological involvement in dengue was previously observed as an encephalopathy mainly due to prolonged shock, hyponatremia and liver failure. Recently, direct neurotropic potential of the virus has been recognized. This study was performed to record the neurological complications in children with dengue infection.Methods: A prospective, cross-sectional study was conducted in 315 consecutive pediatric cases of dengue fever to record the neurological complications and perform detailed clinical evaluation and laboratory assessment. These patients were admitted in the pediatric ward or ICU of the Department of Pediatrics of a tertiary care teaching hospital located 50 km from Jaipur city amidst rural surroundings from 1st January 2016 till 31st October 2017. Appropriate statistical analysis was carried out using SPSS software version 22.0.Results: The neurological complications due to dengue fever was observed in 30 cases (9.5%). The most common symptoms were headache (73.3%, n = 22), altered sensorium (73.3%, n = 22), seizure (73.3%, n = 22), besides fever (100%, n = 30) and vomiting (56.6%, n = 17). The common signs were exaggerated DTR (73.3 %, n = 22), papilloedema (20%, n = 6) and muscle tenderness (13.3%, n = 4) besides hepatomegaly (100%, n = 30), and facial puffiness (66.6%, n = 20). The most commonly observed neurological complications were encephalopathy (53.3%, n = 16), encephalitis (n = 7, 23.3%), myositis (13.3%, n = 4), acute disseminated encephalomyelitis (3.3%, n = 1), hemiplegia with facial palsy (3.3%, n = 1) and intracranial hemorrhage (3.3%, n = 1). Mortality was observed in 3 cases (10%).Conclusions: Neurological complications of dengue in children are relatively uncommon. However, awareness is required for prevention, early recognition, and timely therapeutic intervention to prevent further complications and mortality.
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Deus-Silva, Leonardo, Cheemun Lum, Christine De Meulemeester, and Marlise P. dos Santos. "Severe Aggressive Acute Disseminated Encephalomyelitis–Like Reaction After Aneurysm Coiling." Neurosurgery 66, no. 1 (January 1, 2010): E222—E223. http://dx.doi.org/10.1227/01.neu.0000362001.81386.be.
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Abstract OBJECTIVE Neurointerventional procedures are the first choice of treatment for a variety of cerebrovascular pathologies in many centers worldwide. Although less invasive than conventional traditional surgical approaches, interventional procedures are not exempt from complications. We describe a case of an unusual complication after a coiling procedure where the patient developed severe brain edema induced by contrast media and resembling an aggressive acute disseminated encephalomyelitis–like reaction that was reversed with appropriate therapy. CLINICAL PRESENTATION A 53-year-old, right-handed woman presented with an incidental 4 × 6-mm anterior communicating complex aneurysm, which was successfully coiled with balloon assistance. On the third postcoiling day, she presented to the emergency department with global aphasia, dysarthria, right upper motor neuron pattern facial paresis, and right hemiplegia and hemianesthesia. INTERVENTION The initial intervention was a microballoon-assisted coiling of the anterior communicating complex aneurysm. The intervention for the subsequent complication was high-dose intravenous methylprednisolone for 5 days followed by slow tapering of oral prednisolone. At a 4-month follow-up examination, the patient was asymptomatic and neurologically intact. CONCLUSION We present a case of an unusual complication after a coiling procedure. Considering that endovascular interventional procedures are part of the therapeutic armamentarium for cerebrovascular pathologies, it is of fundamental importance to increase awareness of potential complications that could arise from such interventions.
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Liu, HuaJian, H. Neil Simms, Brian Herron, Sara Hedderwick, Anne Loughrey, and John R. Lindsay. "Cerebral Nocardiosis: A Rare Cause of Hemiplegia in the Acute Medicine Unit." Acute Medicine Journal 18, no. 1 (January 1, 2019): 37–40. http://dx.doi.org/10.52964/amja.0747.
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Nocardiosis, a rare infection occurring mostly in immunosuppressed patients can present with neurological complications including cerebral abscess formation, and is associated with high morbidity and mortality. We describe the case of a 54-year-old immunocompetent man with cerebral nocardiosis, who presented with sudden onset hemiparesis in an acute medicine unit. He required three craniotomies with excision, following failure to respond to antimicrobial therapy, with subsequent clinical improvement and radiological resolution of multiple cerebral abscesses. Challenges in diagnosis and management of hemiparesis in the acute medical unit are discussed. Successful management of cerebral nocardiosis require early communication with a neurosurgical unit, neuropathology and microbiology services to optimise management with targeted antimicrobial therapy.
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Barreto, Leonel, Jean-Bernard Amiel, Anthony Dugard, Nicolas Pichon, Marc Clavel, Bruno François, and Philippe Vignon. "The Rendu-Osler-Weber Disease Revealed by a Refractory Hypoxemia and Severe Cerebral Fat Embolism." Case Reports in Critical Care 2013 (2013): 1–3. http://dx.doi.org/10.1155/2013/434965.
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The Rendu-Osler-Weber disease is a genetic disease which may lead to severe hemorrhage and less frequently to severe organ dysfunction. We report the case of a 22-year-old patient with no personal medical history who was involved in a motorcycle accident and exhibited severe complications related to large arteriovenous pulmonary shunts during his ICU stay. The patient developed an unexplained severe hypoxemia which was attributed to several arteriovenous shunts of the pulmonary vasculature by a contrast study during a transesophageal echocardiographic examination. The course was subsequently complicated by a prolonged coma associated with hemiplegia which was attributed to a massive paradoxical fat embolism in the setting of an untreated femoral fracture. In addition to hemorrhagic complications which may lead to intractable shock, arteriovenous malformations associated with the Rendu-Osler-Weber disease may involve the pulmonary vasculature and result in unexpected complications, such as hypoxemia or severe cerebral fat embolism in high-risk patients.
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Akhtar, Naveed, Abdul Salam, Paula Bourke, Saadat Kamran, Zain Bhutta, Sujatha Joseph, Mark Santos, et al. "DHOW2 score leads to significant improvement in acute stroke care management emergency department: a prospective analysis." BMJ Innovations 5, no. 4 (October 2019): 127–34. http://dx.doi.org/10.1136/bmjinnov-2018-000340.
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BackgroundDelays in transfer of patients from emergency department (ED) to stroke ward increases medical complications. We evaluate if a new risk-score ‘DHOW2’ (dysphagia, hemiplegia, observation-required, wet (incontinence) and weight) will identify high-risk patients and whether expedited admission of ‘high-DHOW2’ score patients to SW will result in fewer complications.MethodsThe DHOW2 score was designed to determine risk of complications following acute stroke. Phase I (279 patients) tested rates of complications with increasing DHOW2. Phase II (1091 patients), evaluated if early admission to the SW of high-DHOW2 patients will lead to fewer complications. Phase III (1257 patients) monitored implementation of the DHOW2 following completion of the study.FindingsMedical complications increased with higher-DHOW2 scores during all three phases; 0%–0.8% with DHOW2 of ≤3, 3.1%–6.5% with DHOW2 of 4–5 and 10.9%–14.1% with DHOW2 of ≥6 (p=<0.001). In phase II, more high-DHOW2 patients were admitted expeditiously to the SW from ED resulting in fewer complications, and fewer deaths. The odds of medical complications with DHOW2 of ≥6 was 36.8–58.3 compared with DHOW2 of ≤3. Expedited SW admission of ‘high-DHOW2 patients’ to within 8 hours reduced the development of complications to odds of 19.18–30.17 (p<0.001).InterpretationsThe DHOW2 score detects patients at risk of AS related medical complications. It is easy to implement in busy EDs where nurses can use the score to identify such patients. The risk stratification by DHOW2 and early transfer of high-scoring patients to SW is associated with significantly fewer complications.
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Kumar, Raj, Anand Kumar Gupta, Ritesh Runu, Sanjay Kumar Pandey, and Manish Kumar. "Clinical profile of cerebral palsy: a study from multidisciplinary clinic at tertiary care centre." International Journal of Contemporary Pediatrics 5, no. 4 (June 22, 2018): 1626. http://dx.doi.org/10.18203/2349-3291.ijcp20182578.
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Background: Cerebral Palsy (CP) is combined disorder of movement, posture, and motor function and may be associated sensory, neurological and musculoskeletal complications. It is a permanent condition attributed to nonprogressive disturbances that occurred in the developing brain. The aim of this study is to Cerebral Palsy (CP) is combined disorder of movement, posture, and motor function and may be associated sensory, neurological and musculoskeletal complications. It is a permanent condition attributed to nonprogressive disturbances that occurred in the developing brain.Methods: Retro prospective cross-sectional study done in super speciality tertiary care centre of East India. Total 70 Children enrolled in multidisciplinary CP clinic in Physical medicine and Rehabilitation (PMR) OPD between September 2017- March 2018.Results: 78.57%male and 21.42% female, all had hospital delivery with 78.5% had normal and 21.5% caesarean section. 70% had history of birth asphyxia and 61.5% required NICU admission. 61.4% had birth wt. less than 2 kg and 10% had birth wt. less than 1kg. One fourth cases had microcephaly and one third had history of seizures. Visual abnormalities, Hearing impairment and history of jaundice were found in about one sixth children. Spastic CP was the most common (76% cases) followed by Dyskinetic 10%, Hyponic and Ataxic (1%). In spastic CP Diplegia was most common (55%), followed by Quadriplegia 24%, Hemiplegia 19% and Monoplegia 2%. GMFCS score 5 was seen in 29% (mostly quadriplegic), followed by GMFCS level 1, 21.27% (mostly hemiplegic), others mostly diplegic in level 3(19%), level 2 and 4 (14%).Conclusions: Male CP are more reaching tertiary care centre in Bihar. Perinatal factors (asphyxia) were main etiological risk factor, and Spastic Diplegia is the most common type of CP. Disability need to be detected at the earliest to facilitate a timely and appropriate intervention like early rehabilitation, special education and psycho-social support.
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Kandel, Michel. "Successful Rehabilitation of a 22-Year-Old Outpatient after Heart Transplantation with Severe Complications." physioscience 14, no. 01 (March 2018): 34–40. http://dx.doi.org/10.1055/s-0044-100542.
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Abstract Background There is a consensus that exercise therapy is an important component in patient rehabilitation after heart transplantation (HTX). Recent studies showed that intensive interval training is more effective than low to moderate intensity training. Several studies described reinnervation of both the para- and sympathetic nervous system. The consequences of these findings have, however, not been implemented and up-to-date guidelines on exercise prescription in HTX do not exist. Furthermore, in clinical practice comorbidity and negative side-effects can aggravate the rehabilitation process after HTX. Objective This case report describes a successful individual rehabilitation programme. Method After an orthotope HTX A 22-year-old male patient suffered from severe complications with a cerebrovascular accident causing a hemiplegia and an acute both-sided renal failure. Massive restrictions in daily activities due to physical, social and psychological factors became apparent. Although these factors affected the rehabilitation process, they did not inhibit the successful application of an intensive interval exercise programme. Results/Conclusions Despite massive initial restrictions the patient well tolerated a consequent exercise therapy programme consisting of high intensity training and attained independency and a better quality of life level.
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Wagle, Suhas D., Pradeep G. Divate, Pradeep M. D'Costa, and Tushar Kalekar. "Acute colon pseudo-obstruction after percutaneous endoscopic gastrostomy: An unusual co-incidence in a case of acute stroke." Journal of Digestive Endoscopy 05, no. 04 (October 2014): 164–67. http://dx.doi.org/10.4103/0976-5042.150670.
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AbstractPercutaneous endoscopic gastrostomy (PEG) is a standard procedure for enteral feeding tube placement in the stomach for patients with nonobstructive dysphagia. Major and minor complications have been described in early and delayed phase. We describe a 57-year-old hypertensive male patient who underwent PEG for nonobstructive dysphagia after an acute cerebro-vascular accident that presented as right hemiplegia due to pontine hemorrhage. Patient went on to develop nonobstructive spontaneous acute colon dilation from cecum to rectum 72 h after the procedure. Computed tomography scan of the abdomen was undertaken to rule out mechanical obstruction or colon entrapment. Injection Neostigmine was used on day 10 after PEG as there was a recurrence after initial partial resolution. Thereafter patient had an uneventful recovery.
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Perry, Avital, Christopher S. Graffeo, Waleed Brinjikji, William R. Copeland, Alejandro A. Rabinstein, and Michael J. Link. "Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report." Journal of Neurosurgery: Spine 28, no. 6 (June 2018): 669–78. http://dx.doi.org/10.3171/2017.10.spine17806.
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Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations. A 43-year-old man presented with 1 week of headache, dizziness, and nausea, which precipitously evolved to hemiplegia. CT venography confirmed CVT, and therapeutic heparin was initiated. He suffered a generalized seizure due to left parietal hemorrhage, which subsequently expanded. He developed signs of mass effect and herniation, heparin was discontinued, and he was taken to the operating room for clot evacuation and external ventricular drain placement. Intraoperatively, the dura was deflated, suggesting underlying SIH. Ventral T-1 CSF leak was identified, which failed multiple epidural blood patches and required primary repair. The patient ultimately made a complete recovery. Systematic review identified 29 publications describing 36 cases of SIH-associated CVT. Among 31 patients for whom long-term neurological outcome was reported, 25 (81%) recovered completely. Underlying coagulopathy/risk factors were identified in 11 patients (31%). CVT is a rare and potentially lethal sequela occurring in 2% of SIH cases. Awareness of the condition is poor, risking morbid complications. Evaluation and treatment should be directed toward identification and treatment of occult CSF leaks. Encouragingly, good neurological outcomes can be achieved through vigilant multidisciplinary neurosurgical and neurocritical care.
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Katyal, Nakul, Amanda Korzep, and Christopher Newey. "Inadvertent Central Arterial Catheterization: An Unusual Cause of Ischemic Stroke." Journal of Neurosciences in Rural Practice 09, no. 01 (January 2018): 155–58. http://dx.doi.org/10.4103/jnrp.jnrp_460_17.
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ABSTRACTCentral venous catheter (CVC) insertion is extensively utilized in Intensive Care Units for evaluation of hemodynamic status, administration of intravenous drugs, and for providing nutritional support in critically ill patients. Unfortunately, CVC use is associated with complications including lung injury, bleeding, infection, and thrombosis. We present a patient with an acute ischemic stroke from an inadvertently placed CVC into the right common carotid artery. A 57-year-old male presented to our institution for left hemiplegia and seizures 2 days after a CVC was placed. He was found to have a right frontal ischemic stroke on computed tomography (CT). CT angiography noted that the catheter was arterial and had a thrombosis around it. He was started on a low-dose heparin infusion. A combination of cardiothoracic surgery and interventional cardiology was required to safely remove the catheter. Central arterial catheterization is an unusual cause for acute ischemic stroke and presents management challenges.
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Loum, Birame, Cheikh Ahmedou Lame, Cheikhna B. Ndiaye, Kamadore Toure, and Mouhamadou Mansour Ndiaye. "Eagle syndrome as a rare cause of recurrent transient ischemic stroke in Senegal (West Africa)." International Journal of Otorhinolaryngology and Head and Neck Surgery 7, no. 9 (August 23, 2021): 1534. http://dx.doi.org/10.18203/issn.2454-5929.ijohns20213294.
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<p>Eagle syndrome is a rare condition, often characterized by nonspecific symptoms. It is due to an abnormally long or compressive styloid process on surrounding structures. Exceptionally, it can cause neuro-vascular manifestations. We report an observation of Eagle syndrome discovered incidentally in presence of recurrent transient ischemic stroke. A 74-year-old man with no cardiovascular risk factors, was admitted to our department following 4 episodes of transient ischemic stroke with right hemiplegia and aphasia, always rapidly resolving. Head and neck CT scan showed 2 long styloid processes with a marked impingement of the left one against the ipsilateral internal carotid artery. Intraoral styloidectomy was performed. The patient recovered fully and remained free of symptoms without neurological impairment, at 6 months. Eagle syndrome is a rare condition which may lead, exceptionally, to repetitive transient ischemic stroke. Surgical styloidectomy must be considered to reduce the risk of new vascular events and prevent serious complications such as dissection of the internal carotid artery.</p>
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Busato, Eduarda Maciel, Jéssica Rodrigues Silva-Meirelles, Monalisa Lukascek de Castro, Rogério Luizari Guedes, Fernando Zanlorenzi Basso, Fernando Wiecheteck de Souza, Ivan Deconto, and Peterson Triches Dornbusch. "Trans-endoscopic ventriculocordectomy in horses using monopolar electrocautery." Semina: Ciências Agrárias 38, no. 5 (October 3, 2017): 3363. http://dx.doi.org/10.5433/1679-0359.2017v38n5p3363.
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Laryngeal hemiplegia is one of the most common upper airway affections in horses. Laringoplasty is indicated in high-performance animals, and when the only complaint is noisy breathing, ventriculectomy and cordectomy can be performed. This study aimed to establish a minimally invasive surgical approach to ventriculocordectomy in horses, through a videoendoscopic procedure. The technique was developed in two stages, the first one was a cadaveric study and the second one was in vivo, both using two flexible endoscopes. A bilateral ventriculocordectomy was performed in two cadavers, totaling the removal of four vocal cords. In the second stage, a left unilateral ventriculocordectomy was performed in three animals with laryngeal hemiplegia. The vocal cords were pulled by one of the endoscopes with 3.2mm grasping forceps, while the second equipment was used for the resection of vocal cords with a flexible electrode adapted for monopolar electrosurgery (electrocautery). The average time for removal of the vocal cords was 23±5 minutes. In the postoperative care, moderate inflammation around the surgical wound was observed, with complete healing in 21 days in one horse and 28 days in the other two. One animal presented exuberant granulation tissue on the surgical site. Other complications due to the tested technique were not noticed; therefore, it could be a less invasive option for ventriculocordectomy in horses. The developed technique proved to be effective for ventriculocordectomy execution in horses. The main advantages of this approach were reduced surgical time, shorter healing average time, no need for daily dressings and return to normal activities in a shorter period when compared to other surgical approaches. The limitation of the technique consists of the need for two endoscopes for its accomplishment. Further studies, with more animals, are needed to improve the technique.
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Gupta, Dr Vipul Kumar, and Dr Akshay Gupta. "Surgical Treatment of Chronic Subdural Hematoma: Clinical Characteristic, Surgical Outcome, Complication and Recurrence Rate." International Journal of Innovative Research in Medical Science 6, no. 05 (May 14, 2021): 292–303. http://dx.doi.org/10.23958/ijirms/vol06-i05/1115.
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Background: Chronic subdural hematoma is one of the most frequent neurosurgical conditions encountered in elderly people (usually, after minor head trauma) and in patients on long term anticoagulation and long term hemodialysis. The aims of this study is to evaluate the clinical characteristics found in chronic subdural hematoma patients & the surgical outcomes, complications and recurrence rate in chronic subdural hematoma patients. Method: A prospective study of surgical treatment of chronic subdural hematoma, clinical characteristics, surgical outcomes, complication and recurrence rate was done over a period of 2 months between 1st June, 2020 and 31st July, 2020 at GMC Jammu. Result: A total of 35 patients of chronic subdural hematoma, 28 males and 7 females underwent surgery. Maximum were in the age group range of 66-70 years and 81-85 years. 20 cases developed SDH after trauma (due to fall) and 15 cases developed spontaneous SDH. The most common presenting complaint of patients seen in our study was hemiplegia/hemiparesis in 26 cases followed by headache in 15 cases. 10 cases were found to have bilateral hematoma. The most common post-operative complication observed was reaccumulation of hematoma seen in 4 cases. In our study out of 35 patients 27 had GCS score of 15. These patients were discharged home earlier post-operatively, with good outcome. Surgical outcome was good in 100% cases & 0% surgical mortality was observed. Conclusion: Burr hole evacuation for chronic subdural hematoma provides significant improvements is neurological status and good outcomes with 0% mortality observed in our study.
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Samaan, M. Constantine, Abeer Alassaf, Jonathan DellaVedova, and Trisha Murthy. "Exercise-Induced Hypoglycemic Hemiplegia in a Child with Type 1 Diabetes: A Rare Find with Multiple Potential Causative Mechanisms." Case Reports in Medicine 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/529097.
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A 10-year-old boy known to have type 1 diabetes presented to the emergency department with history of sudden onset of right-sided hemiplegia after exercise. He did not respond to oral glucose administration, but had an almost immediate resolution of symptoms with intravenous bolus of dextrose. Hemiplegic hypoglycemia is a rare complication in diabetic children, mostly affects the right side of the body, and is rarely recurrent. Children have normal brain imaging and angiography testing, and electroencephalogram may show slow-wave activity. The recovery takes place within 24 hours, and the prognosis is excellent with no focal neurological deficits noted. Our patient responded within minutes to intravenous dextrose, which is unusual and has not been reported previously. The mechanisms leading to development of hypoglycemic hemiplegia are unclear, but may involve effects of hypoglycemia on intracellular signaling pathways or molecules on motor neurons, as recent studies have shown normal brain cell glucose uptake and metabolism in hypoglycemia. While hypoglycemic hemiplegia is rare, it is a frightening experience to caregivers, and efforts should concentrate on its prevention by preventing hypoglycemia.
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Verhofste, Bram P., Michael P. Glotzbecker, Michael T. Hresko, Patricia E. Miller, Craig M. Birch, Michael J. Troy, Lawrence I. Karlin, John B. Emans, Mark R. Proctor, and Daniel J. Hedequist. "Perioperative acute neurological deficits in instrumented pediatric cervical spine fusions." Journal of Neurosurgery: Pediatrics 24, no. 5 (November 2019): 528–38. http://dx.doi.org/10.3171/2019.5.peds19200.
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OBJECTIVEPediatric cervical deformity is a complex disorder often associated with neurological deterioration requiring cervical spine fusion. However, limited literature exists on new perioperative neurological deficits in children. This study describes new perioperative neurological deficits in pediatric cervical spine instrumentation and fusion.METHODSA single-center review of pediatric cervical spine instrumentation and fusion during 2002–2018 was performed. Demographics, surgical characteristics, and neurological complications were recorded. Perioperative neurological deficits were defined as the deterioration of preexisting neurological function or the appearance of new neurological symptoms.RESULTSA total of 184 cases (160 patients, 57% male) with an average age of 12.6 ± 5.30 years (range 0.2–24.9 years) were included. Deformity (n = 39) and instability (n = 36) were the most frequent indications. Syndromes were present in 39% (n = 71), with Down syndrome (n = 20) and neurofibromatosis (n = 12) the most prevalent. Eighty-seven (48%) children presented with preoperative neurological deficits (16 sensory, 16 motor, and 55 combined deficits).A total of 178 (96.7%) cases improved or remained neurologically stable. New neurological deficits occurred in 6 (3.3%) cases: 3 hemiparesis, 1 hemiplegia, 1 quadriplegia, and 1 quadriparesis. Preoperative neurological compromise was seen in 4 (67%) of these new deficits (3 myelopathy, 1 sensory deficit) and 5 had complex syndromes. Three new deficits were anticipated with intraoperative neuromonitoring changes (p = 0.025).Three (50.0%) patients with new neurological deficits recovered within 6 months and the child with quadriparesis was regaining neurological function at the latest follow-up. Hemiplegia persisted in 1 patient, and 1 child died due a complication related to the tracheostomy. No association was found between neurological deficits and indication (p = 0.96), etiology (p = 0.46), preoperative neurological symptoms (p = 0.65), age (p = 0.56), use of halo vest (p = 0.41), estimated blood loss (p = 0.09), levels fused (p = 0.09), approach (p = 0.07), or fusion location (p = 0.07).CONCLUSIONSAn improvement of the preexisting neurological deficit or stabilization of neurological function was seen in 96.7% of children after cervical spine fusion. New or progressive neurological deficits occurred in 3.3% of the patients and occurred more frequently in children with preoperative neurological symptoms. Patients with syndromic diagnoses are at higher risk to develop a deficit, probably due to the severity of deformity and the degree of cervical instability. Long-term outcomes of new neurological deficits are favorable, and 50% of patients experienced complete neurological recovery within 6 months.
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González-Darder, José M. "Combined Extradural and Intradural Pterional Transzygomatic Approach to Large Sphenoid Wing Meningiomas. Operative Technique and Surgical Results." Journal of Neurological Surgery Part B: Skull Base 80, no. 03 (August 21, 2018): 244–51. http://dx.doi.org/10.1055/s-0038-1668538.
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Objectives Describe a unique and safe surgical procedure for the microsurgical management of large sphenoid wing meningiomas (SWMs) aimed to a radical resection of these tumors. Design A prospective series of 26 cases with SWMs larger than 3 cm in one of its main diameter is presented. All patients were studied following the same clinical and imaging procedures. The surgical approach was through a pterional transzygomatic craniotomy. The surgical procedure has the following steps: 1. Extradural tumor devascularization and resection of the hyperostotic and/or infiltrated bone and then intradurally; 2. Intradural tumor debunking; 3. Microdissection of vascular branches and perforators from the capsule; 4. Identification of the optic and oculomotor nerves and internal carotid artery; 5. Tumor capsule dissection and resection; 6. Dural resection or cauterization; 7. Dural and bone reconstruction and closing. Results All lesions were completely removed. Most complications were transient. The most relevant complication was a large middle cerebral artery infarct with permanent hemiplegia despite a decompressive craniotomy. Conclusion Large SWMs can be considered as a single pathology regarding the surgical approach and intraoperative microsurgical procedure strategies. The pterional transzygomatic approach allows an extradural devascularization of the tumor and an extensive bone resection that facilitates the intradural stage of tumor resection. The proposed approach allows a wide and radical resection of the duramater and bone that increases the Simpson grade. However, surgery does not control other biological or molecular prognostic factors involved in tumor recurrence.
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Ibañez Valdés, Lourdes de Fátima, Jerry Geroge, Sibi Joseph, Mohamed Alshmandi, Wendy Makaleni, and Humberto Foyaca Sibat. "Case Report and Literature Review: COVID-19 and status epilepticus in Dyke-Davidoff-Masson syndrome." F1000Research 10 (January 8, 2021): 9. http://dx.doi.org/10.12688/f1000research.27971.1.
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Dyke-Davidoff-Masson syndrome (DMMS) is a non-inherited rare condition with a clinical constellation of hemiparesis/hemiplegia, facial asymmetry, intellectual disability, and epilepsy. The radiological features can be including unilateral cerebral atrophy, calvarial thickening, and hyper pneumatization of the paranasal sinuses. The condition can either be congenital or acquired. The presentation usually occurs during childhood or early adolescents, but there have been adult cases reported. Here we report a 48-year-old male who was a known poorly controlled epileptic that contracted SARS-CoV-2 with subsequently developed status epilepticus and, when worked up, was shown to have features of DDMS. This case is unique as the patient had hemiatrophy and epilepsy but managed to lead a normal, physically demanding, and high functioning academic career and presented late in life. Perhaps only due to coronavirus disease 2019 (COVID-19) was this diagnosis picked up. This report contains a case presenting atypical DDMS in status epilepticus and COVID -19 plus other complications. From our knowledge, this is the first case presenting these comorbidities reported to the medical literature.
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Ibañez Valdés, Lourdes de Fátima, Jerry Geroge, Sibi Joseph, Mohamed Alshmandi, Wendy Makaleni, and Humberto Foyaca Sibat. "Case Report and Literature Review: COVID-19 and status epilepticus in Dyke-Davidoff-Masson syndrome." F1000Research 10 (January 8, 2021): 9. http://dx.doi.org/10.12688/f1000research.27971.1.
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Dyke-Davidoff-Masson syndrome (DMMS) is a non-inherited rare condition with a clinical constellation of hemiparesis/hemiplegia, facial asymmetry, intellectual disability, and epilepsy. The radiological features can be including unilateral cerebral atrophy, calvarial thickening, and hyper pneumatization of the paranasal sinuses. The condition can either be congenital or acquired. The presentation usually occurs during childhood or early adolescents, but there have been adult cases reported. Here we report a 48-year-old male who was a known poorly controlled epileptic that contracted SARS-CoV-2 with subsequently developed status epilepticus and, when worked up, was shown to have features of DDMS. This case is unique as the patient had hemiatrophy and epilepsy but managed to lead a normal, physically demanding, and high functioning academic career and presented late in life. Perhaps only due to coronavirus disease 2019 (COVID-19) was this diagnosis picked up. This report contains a case presenting atypical DDMS in status epilepticus and COVID -19 plus other complications. From our knowledge, this is the first case presenting these comorbidities reported to the medical literature.
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ANGHELESCU, Aurelian, Valentin DEACONU, Catalina AXENTE, and Gelu ONOSE. "Therapeutic difficulties in recurrent, multidrug-resistant epilepsy and vagal nerve stimulation, with recent traumatic brain complications needing iterative neurosurgical interventions." Balneo Research Journal 10, Vol 10 No. 4 (December 10, 2019): 530–34. http://dx.doi.org/10.12680/balneo.2019.294.
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Introduction: Focal epilepsy (possible with secondary generalization) may be a secondary complication to any brain damage (traumatic, vascular, infectious), and is characterized by abnormal excessive neuronal activity with motor, cognitive and psychosocial manifestations. About one third of the patients who suffer from epilepsy have a refractory, multidrug clinical form. Falls are one of the most common medical complications in neurologic patients, occurring during paroxysmal epileptic attacks, or due to sequelary gait limitations. Physical injuries are common, and about 47% patients with epilepsy report at least one injury in the past 12 months. Case presentation: We present a 36-years-old male patient with a medical history of right frontal congenital arteriovenous malformation, ruptured and operated at the age of eight, complicated with left spastic hemiplegia and refractory epilepsy, needing three antiepileptic drugs (AED) and vagus nerve-stimulation (VNS).This presentation was approved by THEBA Bioethics Committee (No.17464/14.06.2019). During a recent epileptic seizure he suffered a severe traumatic brain injury with coma (GCS 5), needing iterative neurosurgical interventions, intensive care supervision, and orotracheal intubation. CT cerebral scan revealed right hemispheric subdural hematoma, operated (on the 2nd May 2019). Rebleeding occurred seven days later, due to an extradural hematoma, and neurosurgical intervention was performed again. The patient was transferred in our neurorehabilitation clinic with left spastic hemiplegia (global motor score was 65/100, and functional independence measure (FIM) 24/91. Neuropsychological assessment revealed an obtunded level of consciousness, depression and dysmnesia for recent events, MMSE 9/30. During hospitalization the patient has continued his previous daily AED treatment with: levetiracetamum 2000 mg + clonazepamum 1mg + carbamazepinum retard 600 mg, associated with VNS. During hospitalization emerged three new short jacksonian seizures, who gave up spontaneously. The overall evolution was favorable with rehabilitation program and psychological support, with improvement of the global motor score, FIM (44/91), and partial restoration of walking ability, but still needing human help. Discussion: The pathophysiological mechanism of relapsed seizures has complex, multiple causes: imbalance of the local brain metabolism and /or a dysfunctional VNS procedure (a possible technical issue due to an impaired electronic device or a bioelectrical one, due to local fibrosis and increased impedance at the contact level between the electrode and the vagal nerve). Specialized technical control disclosed normal electric parameters provided by the electronic device. Other neuromodulatory devices and related technologies, such as deep brain stimulation (DBS) immediately demonstrate their effect control (motor correction) of Parkinson's or dystonic movements. Unfortunately VNS has not the possibility of immediate clinical feed-back control. The AED schedule was modified, by increasing clonazepamum to 2 mg daily. Video-EEG monitoring was recommended. The quod ad vitam prognosis might be unfavorable, because seizures can relapse anytime and evolution is uncontrolled. Furthermore, new brain injures may exacerbate the severity of the epilepsy, any new seizure may worsen the neurologic evolution. The quod ad functionem rehabilitation outcome might be precarious. The family support is essential in the therapeutic efforts. This clinical case underlines the necessity to implement a fall prevention program in patients with epilepsy, the importance of therapeutically tailoring AED for different pathophysiological stages of the disease, and emphasizes the limits of the modern techniques for seizures control. A multi-/ interdisciplinary team management of a such complex clinical case is mandatory. Key words: cerebral arteriovenous malformation, multidrug-resistant (refractory) epilepsy, vagal nerve electrostimulation (VNS), falls, traumatic brain injury,
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Ciliberto, Michael Anthony, David Limbrick, Alexander Powers, Jeffrey B. Titus, Rebecca Munro, and Matthew D. Smyth. "Palliative hemispherotomy in children with bilateral seizure onset." Journal of Neurosurgery: Pediatrics 9, no. 4 (April 2012): 381–88. http://dx.doi.org/10.3171/2011.12.peds11334.
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Object Intractable epilepsy is a significant burden on families and on the cognitive development and quality of life (QOL) of patients. Periinsular hemispherotomy (PIH) for medically intractable epilepsy can benefit patients who qualify for this procedure. The ideal hemispherotomy candidate has ipsilateral ictal and interictal epileptiform activity, unilateral MR imaging abnormalities, contralateral hemiplegia, and a normal contralateral hemisphere. However, certain patients present with a mixed picture of bilateral electroencephalography (EEG) findings and severe intractable epilepsy, prompting consideration of a more aggressive treatment approach. This report introduces the possibility of surgery for patients who normally would not meet criteria for this treatment modality. Methods In this retrospective chart review, the authors report on 7 patients with bilateral seizure onset noted on routine or video-EEG monitoring. A QOL phone questionnaire, based on the Quality of Life in Childhood Epilepsy tool, was administered to a parent. The authors reviewed each patient's chart for surgical complications, changes in examination, QOL, limited neuropsychological outcomes, and seizure outcomes. They also investigated each chart for MR imaging and EEG findings as well as the patient's epilepsy clinic notes for seizure semiology and frequency. Results All patients enjoyed a decrease in seizure frequency and a subjective increase in QOL after PIH. Five patients (71%) achieved Engel Class I or II seizure control. The mean follow-up was 3.64 years (2–5.3 years). One patient is now off all antiseizure medication. No patient had a decrement in Full Scale IQ on postsurgical testing, and 2 (28.5%) of 7 individuals had increased adaptive and social functioning. Postsurgical examination changes included hemiplegia and homonymous hemianopia. Conclusions Hemispherotomy in patients with intractable epilepsy is generally reserved for individuals with unilateral epileptiform abnormalities or lesions on MR imaging. Seven patients in this study benefited from surgery despite bilateral seizure onset with improvement in seizure control and overall QOL. Thus, bilateral ictal onset does not necessarily preclude consideration for hemispherotomy in selected patients with severe medically refractory epilepsy.
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Silva Andrade, Bruno, Sérgio Siqueira, Wagner Rodrigues de Assis Soares, Fernanda de Souza Rangel, Naiane Oliveira Santos, Andria dos Santos Freitas, Priscila Ribeiro da Silveira, et al. "Long-COVID and Post-COVID Health Complications: An Up-to-Date Review on Clinical Conditions and Their Possible Molecular Mechanisms." Viruses 13, no. 4 (April 18, 2021): 700. http://dx.doi.org/10.3390/v13040700.
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The COVID-19 pandemic has infected millions worldwide, leaving a global burden for long-term care of COVID-19 survivors. It is thus imperative to study post-COVID (i.e., short-term) and long-COVID (i.e., long-term) effects, specifically as local and systemic pathophysiological outcomes of other coronavirus-related diseases (such as Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS)) were well-cataloged. We conducted a comprehensive review of adverse post-COVID health outcomes and potential long-COVID effects. We observed that such adverse outcomes were not localized. Rather, they affected different human systems, including: (i) immune system (e.g., Guillain–Barré syndrome, rheumatoid arthritis, pediatric inflammatory multisystem syndromes such as Kawasaki disease), (ii) hematological system (vascular hemostasis, blood coagulation), (iii) pulmonary system (respiratory failure, pulmonary thromboembolism, pulmonary embolism, pneumonia, pulmonary vascular damage, pulmonary fibrosis), (iv) cardiovascular system (myocardial hypertrophy, coronary artery atherosclerosis, focal myocardial fibrosis, acute myocardial infarction, cardiac hypertrophy), (v) gastrointestinal, hepatic, and renal systems (diarrhea, nausea/vomiting, abdominal pain, anorexia, acid reflux, gastrointestinal hemorrhage, lack of appetite/constipation), (vi) skeletomuscular system (immune-mediated skin diseases, psoriasis, lupus), (vii) nervous system (loss of taste/smell/hearing, headaches, spasms, convulsions, confusion, visual impairment, nerve pain, dizziness, impaired consciousness, nausea/vomiting, hemiplegia, ataxia, stroke, cerebral hemorrhage), (viii) mental health (stress, depression and anxiety). We additionally hypothesized mechanisms of action by investigating possible molecular mechanisms associated with these disease outcomes/symptoms. Overall, the COVID-19 pathology is still characterized by cytokine storm that results to endothelial inflammation, microvascular thrombosis, and multiple organ failures.
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ANGHELESCU, Aurelian, Anca Sanda MIHĂESCU, Anca Magdalena MAGDOIU, and Gelu ONOSE. ""Eppur si muove" - Clinical case: evolutionary "saga" during the last 6 years: posttraumatic subdural hematoma, decompressive craniectomy, right hemiplegia and aphasia, cranioplasty, hydrocephalus and porencephaly, post-traumatic encephalopathy - in remission." Balneo Research Journal, Vol.11, no.4 (December 5, 2020): 541–44. http://dx.doi.org/10.12680/balneo.2020.399.
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The case reports a 59-year-old male patient who suffered a severe head injury (affirmative by accidental fall from 3 m) with multiple hemorrhagic lesions (bifrontal, bioccipital, biparieto-temporal) and left cerebral subdural hematoma, requiring a large fronto- temporo-parietal decompressive craniotomy for the mass lesion evacuation. Cranioplasty was performed after 6 months. The paper synthesizes the evolution over six years of follow-up (12 in-patient admissions and 4 out-patient evaluations), like in a neurorehabilitation cinematographic “saga”. The posttraumatic encephalopathy had a peculiar evolution, sugestively compared with the humps of a camel: the brain injury (determined coma, right hemiplegia and mixed aphasia, intense psycho-motor agitation, severe dysphagia for solids and liquids, neurogenic bladder, anemia), was followed by a slowly progressive favorable neuro-psychological evolution (after the decompressive craniectomy). A brutal neurological fall-down was noticed after the cranioplasty, and finally a gradually favorable ascending trend, towards a global neuro-psichological stabilization (with an almost imperceptible sequelary ataxic hemiparesis). The paper discusses the pathophisiological aspects focused on the decompressive craniectomy and cranioplasty, correlated to the patient’s evolution. Complications of each neurosurgical procedures are succinctly depicted. The traumatic encephalopathy was complicated with post-traumatic seizures (therapeutically controlled) and active internal hydrocephalus with interstitial edema and an ischemic lesion. Finally it was a "happyend", with favorable clinical evolution, towards a stable and stationary normotensive asymmetric hydrocephalus, with a gigantic and deforming porencephaly. The paper advocates for a carefully follow-up and prompt intervention in order to prevent recurrences and/ or complications (secondary and tertiary prophylaxis). Keywords: traumatic brain injury, subdural hematoma, decompressive craniectomy; cranioplasty; internal hydrocephalus; post-traumatic encephalopathy; seizures; neurorehabilitation,
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Al-Mefty, Ossama. "Clinoidal meningiomas." Journal of Neurosurgery 73, no. 6 (December 1990): 840–49. http://dx.doi.org/10.3171/jns.1990.73.6.0840.
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✓ Anterior clinoidal meningiomas are frequently grouped with suprasellar or sphenoid ridge meningiomas, masking their notorious association with a high mortality and morbidity rate, failure of total removal, and recurrence. To avoid injury to encased cerebral vessels, most surgeons are content with subtotal removal. Without total removal, however, recurrence is expected. Recent advances in cranial-base exposure and cavernous sinus surgery have facilitated radical total removal. The author reports 24 cases operated on with vigorous attempts at total removal of the tumor with involved dura and bone. This experience has distinguished three groups (I, II, and III) which influence surgical difficulties, the success of total removal, and outcome. These subgroups relate to the presence of interfacing arachnoid membranes between the tumor and cerebral vessels. The presence or absence of arachnoid membranes depends on the origin of the tumor and its relation to the naked segment of carotid artery lying outside the carotid cistern. Total removal was impossible in the three patients in Group I, with postoperative death occurring in one patient and hemiplegia in another. Total removal was achieved in 18 of the 19 patients in Group II, with one death from pulmonary embolism. In the two patients in Group III, total removal without complications was easily achieved.
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Elshahaly, Mohsen, Iman Abd El Latif, and Hassan Bassiouni. "Clinical Characteristics of Behcet’s Disease in 453 Egyptian Patients Suffering from Uveitis with Gender Comparison." Current Rheumatology Reviews 16, no. 4 (December 24, 2020): 285–92. http://dx.doi.org/10.2174/1573397115666191007102317.
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Objective: To describe the clinical features in patients with Behcet’s disease suffering from uveitis in Egypt and to compare the findings between both genders. Methods: 453 subjects fulfilling the 1990 Classification criteria for Behcet’s disease and with uveitis in at least one eye. Follow-up was done for two years. Results: Oral ulcers and recurrent iridocyclitis occurred in all patients during their disease course. The prevalence of genital ulcers, erythema nodosum, and joint involvement were similar between both sexes. The prevalence of all ocular findings was higher in females except for retinal hemorrhages. The incidence of secondary cataract and glaucoma in addition to vitreous opacities was similar between both sexes. 13.7% of patients had GIT manifestations. Vascular complications were present in 128 (28.2%) patients. : Aseptic meningitis and hemiplegia were only found in males. 1.7% of males and 3.2% of females suffered from brainstem involvement. Superior sagittal sinus thrombosis was present in females only. Acute phase reactants (ESR & CRP) were significantly higher in females (p<0.0001). Conclusion: The disease characteristics of BD patients with uveitis in Egypt might be different from the BD patients of other countries. The markers of inflammation were higher in females compared to males. The ocular manifestations were more common in females.
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Li, Jianfeng, Xiaohong Chen, and Jing Zhou. "Internal carotid artery rupture successfully rescued after resection of locally advanced mucosal malignant melanoma of the eustachian tube: a case report." Journal of International Medical Research 48, no. 10 (October 2020): 030006052096300. http://dx.doi.org/10.1177/0300060520963005.
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Mucosal melanoma of the eustachian tube is a rare and highly malignant tumour. Local radical resection combined with radiotherapy and systemic chemotherapy is a classic treatment strategy for this tumour. The internal carotid artery (ICA) is easily damaged when this tumour is removed. Once the ICA ruptures and causes haemorrhage, it can be fatal. We report a case of mucosal malignant melanoma of the eustachian tube with ICA rupture and haemorrhage in a 62-year-old woman 3 days after resection of the tumour. After successful emergency endotracheal intubation, anti-shock treatment was performed. Further, the ICA was examined using digital subtraction angiography under general anaesthesia and the bleeding site was embolized. The patient recovered uneventfully after surgery and was discharged from hospital without hemiplegia, aphasia, or other intracranial complications. Because of economic reasons, the patient discontinued comprehensive treatment after being discharged from the hospital. Finally, she developed bone and kidney metastases 8 months after surgery and died of distant metastases 1.5 years later. When removing eustachian tube lesions, the ICA must be particularly protected. Once the ICA ruptures and there is postoperative haemorrhage, prevention of airway asphyxia, timely anti-shock treatment, and emergency digital subtraction angiography and vascular embolization are effective treatment methods.
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Barnwell, Stanley L., Randall T. Higashida, Van V. Halbach, Christopher F. Dowd, Charles B. Wilson, and Grant B. Hieshima. "Transluminal Angioplasty of Intracerebral Vessels for Cerebral Arterial Spasm: Reversal of Neurological Deficits after Delayed Treatment." Neurosurgery 25, no. 3 (September 1, 1989): 424–29. http://dx.doi.org/10.1227/00006123-198909000-00017.
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Abstract We used intracerebral transluminal angioplasty to treat two episodes of symptomatic vasospasm in a patient recovering from an aneurysmal subarachnoid hemorrhage. The procedures were performed after medical therapies, intravascular volume expansion, and induced arterial hypertension failed to alleviate the patient's neurological condition. The first angioplasty, confined to the right middle cerebral and distal internal carotid arteries, took place more than 30 hours after the onset of left hemiplegia. Despite the subsequent discovery of a small parietal lobe infarct, it brought about a marked improvement in left motor function and may have also limited the spread of necrotic damage. The second angioplasty was necessitated when stenotic segments of the basilar and posterior cerebral arteries caused a 24-hour decline in the patient's mental status. Although delayed in relation to the onset of symptoms, it successfully reversed the patient's comatose state. The use of transluminal angioplasty for vasospasm is generally limited to cases where it can be performed shortly after the onset of neurological symptoms; delaying the procedure increases the risk of hemorrhage from reperfused areas of infarction. Our experience with this patient demonstrates that delayed angioplasty can improve vascular flow to ischemic territory, even after infarction, without complications and with resultant improvement in neurological function.
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Petruševičienė, Daiva, and Aleksandras Kriščiūnas. "Evaluation of activity and effectiveness of occupational therapy in stroke patients at the early stage of rehabilitation." Medicina 44, no. 3 (March 19, 2008): 216. http://dx.doi.org/10.3390/medicina44030028.
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In Lithuania, the stroke is not only medical, but social issue as well, since only 20% of patients suffering from stroke remain active at work. Yearly stroke incidence in Lithuania is 7000–8000 cases. The most common outcome of stroke is unilateral paralysis (hemiplegia) followed by disorders of coordination, balance, and movements. Due to dysfunctions of movements, self-care, cognition, behavior, and communication, some part of stroke patients remains disabled. They need assistance and care provided by other people. Occupational therapy, which is part of rehabilitation of patients after stroke, is directed to independence training. There are scarce data related to effectiveness of occupational therapy depending on motor, cognitive, and psychosocial dysfunctions. Goals of study were to estimate effectiveness of occupational therapy at the early stage of rehabilitation depending on type of stroke, localization of brain injury, grade of lesion, age, and gender, to identify factors influencing effectiveness of occupational therapy, and to estimate their positive predictive value. The study included 106 patients at the early stage of rehabilitation, who were admitted to Department of Neurorehabilitation after stabilization of clinical condition from Departments of Neurology and Neurosurgery (mean duration of 14±2 days after stroke). The program of occupational therapy was not fulfilled by 6 patients: 2 patients were transferred to Nursing Hospital due to severe condition, and 4 patients were discharged prematurely and continued rehabilitation in outpatient setting. Hence, study population consisted of 100 subjects (47 men and 53 women) who were diagnosed with stroke (ischemic or hemorrhagic). Patient’s functional status and disorders of activities were evaluated using Barthel Index and Functional Independence Measure. Complexes of occupational therapy were adjusted according to examination of patient’s disorders of activities, age, grade of lesion, other diseases, and complications during rehabilitation process. Effectiveness of occupational therapy in patients after stroke at then early stage of rehabilitation was influenced by gender, age, degree of lesion, type of stroke. Better effectiveness of occupational therapy was observed in men (P<0.05), persons younger than 59 years (P<0.05), persons with hemiparesis (P<0.05) and hemorrhagic stroke (P<0.05). Low effectiveness in stroke patients at the early stage of rehabilitation was influenced by neglect (P<0.05), hemiplegia (P<0.001), and older age of patient (P<0.05). Application of individualized occupational therapy complexes for stroke patients at the early stage of rehabilitation with consideration of motoric and cognitive-psychosocial disorders, significantly improves recovery of impaired functions, though occupational therapy should be continued in later rehabilitation stages, since patients after early stage of rehabilitation still have limited independence in daily activities.
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Sousa, Sandra, Nuno Vasco Costa, Cátia Carmona, Élia Coimbra, and Fernando Pita. "Recurrent Stroke in a Young Woman with a Single Pulmonary Arteriovenous Fistula: An Unusual Association." Case Reports in Neurology 9, no. 3 (December 18, 2017): 293–98. http://dx.doi.org/10.1159/000484682.
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Introduction: Cryptogenic stroke is present in about 40% of ischemic stroke patients. Extracardiac shunt related to pulmonary arteriovenous fistula (PAVF) could be a rare potential risk factor for embolic stroke. Most PAVFs are multiple, congenital, and associated with hereditary conditions. On the other hand, isolated PAVFs are rare conditions and an uncommon cause of cryptogenic stoke. Case Report: We describe a case of a young woman without history of respiratory diseases or vascular risk factors, who presented with acute onset of transitory aphasia and right hemiplegia. She had a history of a transient ischemic attack, 3 years before, and migraine headaches. Brain MRI showed an acute cortical ischemic lesion and a chronic ischemic lesion. Diagnostic workup with transcranial Doppler ultrasonography revealed a significant right-to-left shunt with curtain pattern, and echocardiogram did not show structural abnormalities. An isolated small PAVF was diagnosed on pulmonary angiogram. Despite the rare association between isolated small PAVF and stroke, we decided to treat it with coil embolization because of recurrence of stroke, cortical lesions suggestive of embolic source, significant right-left shunt, and risk of future complications. Conclusions: This case highlights the importance of search, identification, and interpretation of causes of cryptogenic strokes to better choose therapy to reduce the stroke recurrence risk. Although unusual, PAVF detection is a treatable cause of stroke and the therapeutic decisions should take into account the characteristics of the PAVF and the degree of suspicion regarding the cause-effect relationship between PAVF and stroke.
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Clyde, Brent L., Andrew D. Firlik, Anthony M. Kaufmann, MichaelP Spearman, and Howard Yonas. "Paradoxical aggravation of vasospasm with papaverine infusion following aneurysmal subarachnoid hemorrhage." Journal of Neurosurgery 84, no. 4 (April 1996): 690–95. http://dx.doi.org/10.3171/jns.1996.84.4.0690.
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✓ Reports of intraarterial papaverine infusion as treatment for cerebral vasospasm are few and documented complications are uncommon. The authors report the case of a patient with paradoxical aggravation of cerebral arterial narrowing during selective intraarterial papaverine infusion intended to treat vasospasm following aneurysmal subarachnoid hemorrhage (SAH). A 48-year-old man presented to the authors' service with symptomatic vasospasm 10 days after experiencing an SAH. The ruptured anterior communicating artery aneurysm was surgically obliterated the following day, and thereafter maximum hypervolemic and hypertensive therapies were used. However, the patient remained lethargic, and a stable xenon—computerized tomography (CT) cerebral blood flow (CBF) study revealed CBF to be 15 cc/100 g/minute in the left anterior cerebral artery (ACA) and 25 cc/100 g/minute in the right ACA territories. Cerebral arteriography demonstrated diffuse severe left ACA and mild left middle cerebral artery (MCA) vasospasm. In response intraarterial papaverine was infused into the internal carotid artery just proximal to the ophthalmic artery. During the infusion the patient became aphasic and exhibited right hemiplegia. Arteriography performed immediately after the intraarterial papaverine infusion revealed diffuse exacerbation of vasospasm in the distal ACA and MCA territories. A repeat xenon—CT CBF study showed that CBF in the left ACA and the MCA had drastically decreased (2 cc/100 g/minute and 10 cc/100 g/minute, respectively). Despite aggressive management, infarction ultimately developed. This is the first clinical case to illustrate a paradoxical effect of intraarterial papaverine treatment for vasospasm following aneurysmal SAH. The possible mechanisms of this paradoxical response and potential therapeutic reactions are reviewed.
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McGeachan, Robert I., Tobias Schwarz, Danièlle A. Gunn-Moore, and Katia Marioni-Henry. "Botulinum toxin type A for the treatment of muscle contractures secondary to acute spinal cord injury in a young cat." Journal of Feline Medicine and Surgery Open Reports 6, no. 1 (January 2020): 205511692092264. http://dx.doi.org/10.1177/2055116920922648.
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Case summary A 4-month-old male entire domestic shorthair cat presented for sudden onset of right thoracic monoparesis following a fall; within 18 h, the clinical signs progressed to non-ambulatory right hemiplegia with absent sensation in the distal right thoracic limb and left hemiparesis. MRI revealed changes consistent with a C6–C7 acute non-compressive nucleus pulposus extrusion with suspected secondary C5–C7 spinal cord haemorrhage. Rehabilitation exercises were started immediately after the diagnosis of acute spinal cord trauma. Sensation in the right thoracic limb improved and, with the help of a splint applied to that limb, the cat was ambulatory on all four limbs. Unfortunately, clinical signs started to progress over the course of 10 days. The cat developed progressive discomfort on manipulation of the right elbow and carpus, and a hyperflexion of the right carpus. Radiographs revealed no skeletal abnormalities. Muscle contractures were suspected. Under general anaesthesia the triceps and flexor muscles of the carpus and digits were injected with a total of 100 U of botulinum toxin type A (BTX-A). No complications were associated with the procedure and 24 h after the injection the carpal hyperflexion resolved. Relevance and novel information The use of BTX-A to treat muscle contractures in human medicine is an established and increasingly used technique. For example, in subacute stroke patients with a non-functional arm, BTX-A forearm injection appears to prevent disabling finger stiffness, likely by minimising the development of contractures. Here, we demonstrate that intramuscular BTX-A is an effective treatment for acquired muscle contractures in a cat.
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Bhowmik, Nirmalendu Bikash, Mohammad Saifuddin, Rajib Bhadra, Md Rashedul Islam, Rumana Habib, Aminur Rahman, Md Zahid Hassan, and Md Amirul Haque. "Territorial location of cerebral infarcts on imaging in patients with first ever stroke with diabetes." Bangladesh Critical Care Journal 2, no. 1 (August 11, 2014): 16–20. http://dx.doi.org/10.3329/bccj.v2i1.19951.
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Aims: The study was aimed to evaluate vascular territories of infarcts involved in patients with stroke for the first time with diabetes on CT and/ or MRI of brain. Methodology: This cross sectional descriptive study was carried on a total of 100 adult patients with first ever stroke consecutively reported in the Department of Neurology, BIRDEM General Hospital, Dhaka, over a period of six months. Results: The mean age was 61.45 years and majority (35%) belongs to age group of 50-59. Ten (10%) subjects had age above 80 years. Male were 68% and 32% were female. Majority (89%) of the subjects had hemiplegia following acute stroke. Aphasia (71%), headache (39%), convulsion (23%), vomiting (18%) and cranial nerve palsy (17%) were also found. Additional preexisting risk factors were hypertension (72%), dyslipidaemia (59%), smoking (56%) and alcohol abuse (2%). Among the study subjects the diabetic complications were peripheral vascular disease (4% ), neuropathy (8%), nephropathy( 9%)and retinopathy(25%). CT scan and/ or MRI brain showed parietal lobe lesion in 57% cases. Majority (76%) had infarcts in middle cerebral artery territory. Involvement of anterior and posterior cerebral artery territory was found in 7% and 5% subjects respectively. Vertebro-basilar arterial system involvement was observed in 6% cases. 4% subjects had involvement of both middle and posterior cerebral arteries. Both anterior and posterior arterial territory infarcts were found in 2% cases. Conclusions: In conclusion most of the diabetic subjects with first ever ischemic stroke had involvement of middle cerebral artery. DOI: http://dx.doi.org/10.3329/bccj.v2i1.19951 Bangladesh Crit Care J March 2014; 2 (1): 16-20
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Nakagawa, Ichiro, Hun Soo Park, Masashi Kotsugi, Yudai Morisaki, Takeshi Wada, Shuta Aketa, Katsutoshi Takayama, et al. "Delayed Intracranial Parenchymal Changes After Aneurysmal Coil Embolization Procedures for Unruptured Intracranial Aneurysms." Operative Neurosurgery 19, no. 1 (October 4, 2019): 76–83. http://dx.doi.org/10.1093/ons/opz299.
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Abstract BACKGROUND With the recent advances in endovascular treatment devices, it has become standard in wide-neck or large intracranial aneurysms to perform coil embolization with adjunctive techniques. However, device-related perioperative complications have been reported because of the use of more complex systems. OBJECTIVE To investigate patients who developed multiple parenchymal lesions after undergoing coil embolization for treating an unruptured intracranial aneurysm. METHODS This study investigated 305 consecutive patients who underwent coil embolization of unruptured intracranial aneurysms between 2015 and 2017. Delayed inflammatory changes referred to the delayed observation of multiple cerebral white matter lesions on follow-up magnetic resonance imaging at an area corresponding to the perfused area of the treatment target vessel. The timing and pattern of onset, device used, the combined use of adjunctive techniques, and the clinical course after steroid treatment were retrospectively investigated. RESULTS The 7 patients (2.3%) who showed delayed inflammatory changes were all women with a mean age of 59 yr. A mean duration from treatment to onset was 28 d. Symptoms were convulsions in 3 patients, hemiplegia in 2 patients, and homonymous hemianopia in 1 patient. All 7 patients were treated with adjunctive technique including stents, double catheter method, and balloon assist. Response to steroid treatment was satisfactory both clinically and on imaging in all 7 patients. Skin patch test was positive for nickel allergy in 2 patients. CONCLUSION Clinicians must be fully aware of symptomatic delayed inflammatory changes may occur after endovascular aneurysmal treatment with the use of various devices.
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Wiem, Romdhane, Arfa Sondess, Chelly Jihene, Jomaa Olfa, Hammami Sonia, Hmida Karima, El Arbi Fatma, and Berriche Olfa. "Case Report: Cerebral venous thrombosis revealing celiac disease." F1000Research 10 (September 10, 2021): 680. http://dx.doi.org/10.12688/f1000research.54233.2.
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Celiac disease (CD) is an autoimmune enteropathy resulting from intolerance of an individual genetically predisposed to gluten. It has a large clinical polymorphism ranging from a classic digestive clinical presentation due to the malabsorption syndrome to extra-intestinal symptoms. Among the hematologic abnormalities, venous thromboembolic disease (VTE) has been reported, and they are most often located in the abdomen or lower limbs, but the cerebral localization was exceptionally described. We report a case of CD revealed by cerebral thrombophlebitis. A 44-year-old patient with no medical history and no drug intake, presented with hemiplegia followed by a status epilepticus in a context of apyrexia, initially hospitalized in intensive care. Magnetic imaging resonance displayed a cerebral venous thrombosis of the sigmoid sinus requiring anticoagulant treatment, then transferred to our department for the etiological investigation. On questioning, the patient reported chronic diarrhea and weight loss with no other associated symptoms. The examination revealed an underweight patient with pale conjunctiva, improvement of her deficit symptoms, and no other abnormalities. Laboratory tests noted biological signs of malabsorption. The thrombophilia assessment revealed a protein C deficiency with a slight increase in anticardiolipin antibodies and anti-Beta 2 glycoprotein 1 antibodies. Immunological tests noted positives anti-transglutaminase and IgA anti-endomysium antibodies. Duodenal biopsy demonstrated villous atrophy. After ruling out the other causes of VTE, the diagnosis of cerebral venous thrombosis secondary to CD was retained. Early diagnosis and treatment of CD improves the quality-of-life for patients and may spare them various long-term or even fatal complications.
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Takahashi, Toshihide, Go Ikeda, Haruki Igarashi, Takahiro Konishi, Kota Araki, Kei Hara, Ken Akimoto, et al. "Emergent carotid artery stenting for cervical internal carotid artery injury during carotid endarterectomy: A case report." Surgical Neurology International 12 (March 17, 2021): 109. http://dx.doi.org/10.25259/sni_806_2020.
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Background: Carotid endarterectomy (CEA) has been the standard preventive procedure for cerebral infarction due to cervical internal carotid artery stenosis, and internal shunt insertion during CEA is widely accepted. However, troubleshooting knowledge is essential because potentially life-threatening complications can occur. Herein, we report a case of cervical internal carotid artery injury caused by the insertion of a shunt device during CEA. Case Description: A 78-year-old man with a history of hypertension, diabetes, and hyperuricemia developed temporary left hemiplegia. A former physician had diagnosed the patient with a transient cerebral ischemic attack. The patient’s medical history was significant for the right internal carotid artery stenosis, which was severe due to a vulnerable plaque. We performed CEA to remove the plaque; however, there was active bleeding in the distal carotid artery of the cervical region after we removed the shunt tube. Hemostasis was achieved through compression using a cotton piece. Intraoperative digital subtraction angiography (DSA) revealed severe stenosis at the internal carotid artery distal to the injury site due to hematoma compression. The patient underwent urgent carotid artery stenting and had two carotid artery stents superimposed on the injury site. On DSA, extravascular pooling of contrast media decreased on postoperative day (POD) 1 and then disappeared on POD 14. The patient was discharged home without sequela on POD 21. Conclusion: In the case of cervical internal carotid artery injury during CEA, hemostasis can be achieved by superimposing a carotid artery stent on the injury site, which is considered an acceptable troubleshooting technique.
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Wiem, Romdhane, Arfa Sondess, Chelly Jihene, Jomaa Olfa, Hammami Sonia, Hmida Karima, El Arbi Fatma, and Berriche Olfa. "Case Report: Cerebral venous thrombosis revealing celiac disease." F1000Research 10 (July 28, 2021): 680. http://dx.doi.org/10.12688/f1000research.54233.1.
Full textAbstract:
Celiac disease (CD) is an autoimmune enteropathy resulting from intolerance of an individual genetically predisposed to gluten. It has a large clinical polymorphism ranging from a classic digestive clinical presentation due to the malabsorption syndrome to extra-intestinal symptoms. Among the hematologic abnormalities, venous thromboembolic disease (VTE) has been reported, and they are most often located in the abdomen or lower limbs, but the cerebral localization was exceptionally described. We report a case of CD revealed by cerebral thrombophlebitis. A 44-year-old patient with no medical history and no drug intake, presented with hemiplegia followed by a status epilepticus in a context of apyrexia, initially hospitalized in intensive care. Magnetic imaging resonance displayed a cerebral venous thrombosis of the sigmoid sinus requiring anticoagulant treatment, then transferred to our department for the etiological investigation. On questioning, the patient reported chronic diarrhea and weight loss with no other associated symptoms. The examination revealed an underweight patient with pale conjunctiva, improvement of her deficit symptoms, and no other abnormalities. Laboratory tests noted biological signs of malabsorption. The thrombophilia assessment revealed a protein C deficiency with a slight increase in anticardiolipin antibodies and anti-Beta 2 glycoprotein 1 antibodies. Immunological tests noted positives anti-transglutaminase and IgA anti-endomysium antibodies. Duodenal biopsy demonstrated villous atrophy. After ruling out the other causes of VTE, the diagnosis of cerebral venous thrombosis secondary to CD was retained. Early diagnosis and treatment of CD improves the quality-of-life for patients and may spare them various long-term or even fatal complications.
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Agarwal, Neha, and Sunil Taneja. "Unusual manifestations of malaria in children." International Journal of Contemporary Pediatrics 8, no. 5 (April 27, 2021): 910. http://dx.doi.org/10.18203/2349-3291.ijcp20211685.
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Background: Till recently, vivax malaria was being regarded as a “benign” disease. Falciparum malaria is known to be a serious illness with life threatening complications as cerebral malaria, jaundice, acute kidney injury, metabolic acidosis and bleeding diatheses. Recently, some other atypical presentations are also, being noted, which have hardly been discussed previously. The present report highlights the various unusual presentations of malaria in children.Methods: The study design was hospital based prospective observational study conducted over one year. Children between the ages of 1 month to 18 years admitted with a diagnosis of malaria confirmed by peripheral blood smear examination and/or rapid diagnostic test having unusual manifestations were studied. Patients with dengue fever, enteric fever, viral hepatitis, or any other infection were excluded. The various unusual manifestations of malaria, disease course and outcome were analysed.Results: 58 (27.1%) out of 214 patients studied were found to have atypical manifestations. The unusual features observed were ARDS in vivax malaria (n=11), fulminant hepatic failure (n=5), post malaria neurological syndrome (n=3), stroke (n=3), bilateral optic neuritis (n=1), abducens nerve palsy (n=1), autoimmune haemolytic anemia (n=1), nephrotic syndrome (n=1), splenic infarction (n=2), acute abdomen (n=2), hemiplegia (n=2), psychomotor agitation (n=7), sepsis (n=5), shock (n=3), disseminated intravascular coagulation (n=3) and urticaria (n=2). Six children with vivax presented in deep coma.Conclusions: Clinicians in endemic areas should be aware of unusual and varied presentations of malaria; failure of recognition of which may lead to delayed diagnosis resulting in increased mortality.
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Isaias, Lidiane Cristina Silva, Iara Sayuri Shimizu, Tássio Breno De Sousa Lopes Lavôr, and Gabriela de Sousa Dantas Cunha. "EVOLUÇÃO CLÍNICA DE PACIENTES COM ANEURISMA CEREBRAL INTERNADOS EM UM HOSPITAL PÚBLICO." Revista Interdisciplinar de Estudos em Saúde 7, no. 2 (December 1, 2018): 156–67. http://dx.doi.org/10.33362/ries.v7i2.1436.
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Este estudo tem como objetivo analisar a evolução clínica de pacientes com aneurisma cerebral internados aguardando neurocirurgia de embolização; acompanhar e registrar a evolução clínica e complicações desses pacientes durante a internação hospitalar; identificar a média de tempo de permanência de internação hospitalar na enfermaria neurológica e caracterizar os motivos relacionados com a permanência hospitalar desses pacientes. Trata-se de uma pesquisa longitudinal, descritiva e prospectiva realizada na Clínica Neurológica de um Hospital Público, de julho a outubro de 2017 com pacientes diagnosticados com aneurisma cerebral e aguardando microcirurgia de embolização. Amostra composta por 51 pacientes, sendo 74,51% do sexo feminino, com idade da amostra variando entre 24 a 77 anos, com idade média de 53,45 anos, ± 11,78. A Hemiplegia foi o déficit motor mais presente na admissão e alta. O desfecho óbito esteve presente em 11,76 %. A média de permanência hospitalar foi de 20,1 dias. A embolização demostrou ser uma cirurgia favorável ao desfecho clínico do paciente, já que os óbitos estiveram mais relacionados com piora clínica antes do procedimento. O tempo de permanência hospitalar foi maior que o da literatura encontrada e carência de vaga de UTI foi o motivo mais frequente para permanência no leito aguardando agendamento e para suspensão de cirurgias já agendadas interferindo diretamente no tempo de permanência hospitalar.Palavras-chave: Aneurisma Intracraniano. Embolização Terapêutica. Tempo de Permanência. Evolução Clínica. CLINICAL EVOLUTION OF PATIENTS WITH CEREBRAL ANEURYSM HOSPITALIZED IN A PUBLIC HOSPITAL ABSTRACT: This study aims to analyze the clinical evolution of patients with cerebral aneurysms hospitalized waiting for neurosurgery of embolization; monitor and record the clinical course and complications of these patients during hospitalization; to identify the average length of hospital stay in the neurological ward and to characterize the reasons related to the hospital stay of these patients. This is a longitudinal, descriptive and prospective study conducted at the Neurological Clinic of a Public Hospital from July to October 2017 with patients diagnosed with cerebral aneurysm and awaiting embolization microsurgery. The sample consisted of 51 patients, 74.51% female, with a sample age ranging from 24 to 77 years, mean age of 53.45 years, ± 11.78. Hemiplegia was the most present motor deficit at admission and discharge. The death outcome was present in 11.76%. The mean hospital stay was 20.1 days. Embolization proved to be favorable surgery for the clinical outcome of the patient, since the deaths were more related to clinical worsening before the procedure. The length of hospital stay was higher than that of the literature found and lack of ICU vacancy was the most frequent reason for stay in bed waiting for scheduling and for suspension of surgeries already scheduled interfering directly in the length of hospital stay.Keywords: Intracranial Aneurysm. Therapeutic Embolization. Lenght of stay. Clinical Evolution.
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Sarecka-Hujar, Beata, Ilona Kopyta, and Dorota Raczkiewicz. "Risk factors, types and outcomes of arterial ischemic stroke in Polish pediatric patients: a retrospective single-center study." Archives of Medical Science 17, no. 1 (January 5, 2021): 62–70. http://dx.doi.org/10.5114/aoms.2017.71805.
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IntroductionVarious neurological complications may occur as a consequence of arterial ischemic stroke (AIS) and have an impact on daily activity of the patients, costs of their medical care and rehabilitation. The aim of this study was to analyze risk factors, stroke symptoms and post-stroke consequences in Polish pediatric patients depending on stroke subtype.Material and methodsWe retrospectively reviewed 77 children under the age of 18 years following their first AIS. Patients were white, Polish Caucasians, recruited in the Department of Pediatric Neurology at the Medical University of Silesia in Katowice (Poland). Statistical analysis was performed using Statistica 12.0.ResultsGender differed significantly between stroke subgroups (p = 0.030). The presence of focal cerebral arteriopathy (FCA) and chronic diseases was associated with type of AIS (p = 0.003 and p = 0.050, respectively). An outcome without neurological deterioration (normal outcome) was observed in 43% of children with lacunar anterior circulation infarct (LACI). Hemiparesis was present in almost all children with total anterior circulation infarct (TACI), in two thirds of children with partial anterior circulation infarct (PACI) and in almost 50% of children with LACI or posterior circulation infarct (POCI). In every child with hemiplegia the stroke symptom evolved into hemiparesis at follow-up. Additionally, patients with a normal outcome were older at the time of AIS than those with at least one neurological consequence (OR = 0.894, p = 0.034).ConclusionsThe presence and number of neurological outcomes depend on stroke subtypes. A relation between the presence of post-stroke deficits and age at onset was observed. The odds of deficit after ischemic stroke decreases by an average of 10.6% if the child is 1 year older at the time of AIS.
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Wahezi, Sayed E. "Hemiparesis and Facial Sensory Loss following Cervical Epidural Steroid Injection." Pain Physician 6;17, no. 6;12 (December 14, 2014): E761—E767. http://dx.doi.org/10.36076/ppj.2014/17/e761.
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Interlaminar cervical epidural steroid injections (ic-ESI) are safe and effective treatment options for the management of acute and chronic radiculopathy, spinal stenosis, and other causes of neck pain not responding to more conservative measures. However, the procedure inherently lends itself to possible spinal cord injury (SCI). Though reports of such events have been documented, the clinical presentation of patients with needle puncture SCI varies. In part, this may be due to anatomic considerations, as symptoms may be dependent on the cervical level intruded, as well as the volume and type of injectate used. Many cases go unreported and therefore the true incidence of cord injections during ic-ESI is not known. Cervical epidurals can be performed by the transforaminal or interlaminar approach. It is generally accepted that ic-ESI is safer than transforaminal epidurals. There are numerous reports of arterial invasion or irritation with the latter despite an inherently greater risk of cord puncture with the former. The likelihood of cord interruption rises when ic-ESIs are performed above C6-C7 as there is a relatively slim epidural layer compared to lower cervical epidural zones. Though most cases of devastating outcomes, such as hemiplegia and death, have been reported during cervical transforaminal epidural injections and rarely with ic-ESI, it is important to understand the symptoms and potential pitfalls of performing any cervical epidural injection. Cervical epidural malpractice claims are uncommon, but exceed those of steroid blocks at all the levels combined, demonstrating the need for improved awareness of potential complications in ic-ESI. Here, we will describe an unusual presentation of a spinal cord injection during an ic-ESI procedure. Key words: Cervical epidural, spinal cord, hemiparesis
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McNeil, J. D., and M. Horowitz. "Contralateral Hemiplegia Complicating Herpes Zoster Ophthalmicus." Journal of the Royal Society of Medicine 84, no. 8 (August 1991): 501–2. http://dx.doi.org/10.1177/014107689108400820.
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IŞIK, Yasemin, Muhammed Bilal ÇEGİN, İsmail KATI, Uğur GÖKTAŞ, and Nesrin Burcu KAYA ÇİMEN. "A Rare Complication of Scorpion Sting: Hemiplegia: Case Report." Turkiye Klinikleri Journal of Case Reports 24, no. 2 (2016): 127–30. http://dx.doi.org/10.5336/caserep.2015-43728.
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