scholarly journals An Atypical Case of Taravana Syndrome in a Breath-Hold Underwater Fishing Champion: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Andrea Cortegiani ◽  
Grazia Foresta ◽  
Giustino Strano ◽  
Maria Teresa Strano ◽  
Francesca Montalto ◽  
...  
Keyword(s):  
Sea Water ◽  
Neurological Impairment ◽  
Clonic Seizure ◽  
Breath Hold ◽  
Temporal Region ◽  
Blurred Vision ◽  
Atypical Case ◽  
Free Interval ◽  
Imaging Characteristics ◽  
The Brain

Dysbaric accidents are usually referred to compressed air-supplied diving. Nonetheless, some cases of decompression illness are known to have occurred among breath-hold (BH) divers also, and they are reported in the medical literature. A male BH diver (57 years old), underwater fishing champion, presented neurological disorders as dizziness, sensory numbness, blurred vision, and left frontoparietal pain after many dives to a 30–35 meters sea water depth with short surface intervals. Symptoms spontaneously regressed and the patient came back home. The following morning, pain and neurological impairment occurred again and the diver went by himself to the hospital where he had a generalized tonic-clonic seizure and lost consciousness. A magnetic resonance imaging of the brain disclofsed a cortical T1-weighted hypointense area in the temporal region corresponding to infarction with partial hemorrhage. An early hyperbaric oxygen therapy led to prompt resolution of neurological findings. All clinical and imaging characteristics were referable to the Taravana diving syndrome, induced by repetitive prolonged deep BH dives. The reappearance of neurological signs after an uncommon 21-hour symptom-free interval may suggest an atypical case of Taravana syndrome.

Central Nerve System Impairment, AMA Guides, Sixth Edition: An Overview

2018 ◽  
Vol 23 (1) ◽  
pp. 10-13
Author(s):  
James B. Talmage ◽  
Jay Blaisdell
Keyword(s):  
Spinal Cord ◽  
Central Nervous System ◽  
Nervous System ◽  
Neurological Impairment ◽  
Sixth Edition ◽  
Central Nerve System ◽  
The Central Nervous System ◽  
The One ◽  
Nerve System ◽  
The Brain

Abstract Injuries that affect the central nervous system (CNS) can be catastrophic because they involve the brain or spinal cord, and determining the underlying clinical cause of impairment is essential in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), in part because the AMA Guides addresses neurological impairment in several chapters. Unlike the musculoskeletal chapters, Chapter 13, The Central and Peripheral Nervous System, does not use grades, grade modifiers, and a net adjustment formula; rather the chapter uses an approach that is similar to that in prior editions of the AMA Guides. The following steps can be used to perform a CNS rating: 1) evaluate all four major categories of cerebral impairment, and choose the one that is most severe; 2) rate the single most severe cerebral impairment of the four major categories; 3) rate all other impairments that are due to neurogenic problems; and 4) combine the rating of the single most severe category of cerebral impairment with the ratings of all other impairments. Because some neurological dysfunctions are rated elsewhere in the AMA Guides, Sixth Edition, the evaluator may consult Table 13-1 to verify the appropriate chapter to use.

Drusen in the Peripheral Retina of the Alzheimer’s Eye

2018 ◽  
Vol 15 (8) ◽  
pp. 743-750 ◽  
Author(s):  
Kresimir Ukalovic ◽  
Sijia Cao ◽  
Sieun Lee ◽  
Qiaoyue Tang ◽  
Mirza Faisal Beg ◽  
...  
Keyword(s):  
Peripheral Retina ◽  
Amyloid Angiopathy ◽  
Temporal Region ◽  
Future Studies ◽  
Eye Tissues ◽  
Neuropathological Diagnosis ◽  
Ocular Imaging ◽  
Cerebral Amyloid ◽  
The Brain ◽  
Oil Red O

Background: Recent work on Alzheimer's disease (AD) diagnosis focuses on neuroimaging modalities; however, these methods are expensive, invasive, and not available to all patients. Ocular imaging of biomarkers, such as drusen in the peripheral retina, could provide an alternative method to diagnose AD. Objective: This study compares macular and peripheral drusen load in control and AD eyes. Methods: Postmortem eye tissues were obtained from donors with a neuropathological diagnosis of AD. Retina from normal donors were processed and categorized into younger (<55 years) and older (>55 years) groups. After fixation and dissection, 3-6 mm punches of RPE/choroid were taken in macular and peripheral (temporal, superior, and inferior) retinal regions. Oil red O positive drusen were counted and grouped into two size categories: small (<63 μm) and intermediate (63-125 μm). Results: There was a significant increase in the total number of macular and peripheral hard drusen in older, compared to younger, normal eyes (p<0.05). Intermediate hard drusen were more commonly found in the temporal region of AD eyes compared to older normal eyes, even after controlling for age (p<0.05). Among the brain and eye tissues from AD donors, there was a significant relationship between cerebral amyloid angiopathy (CAA) severity and number of temporal intermediate hard drusen (r=0.78, p<0.05). Conclusion: Imaging temporal drusen in the eye may have benefit for diagnosing and monitoring progression of AD. Our results on CAA severity and temporal intermediate drusen in the AD eye are novel. Future studies are needed to further understand the interactions among CAA and drusen formation.

scholarly journals Medico-Legal Opinion Based on Autopsy Findings of a Victim of an Explosion Involving Mass Fatality

2020 ◽  
Vol 10 (3-4) ◽  
pp. 158-165
Author(s):  
Yalini Thivaharan ◽  
Indira Deepthi Gamage Kitulwatte
Keyword(s):  
Legal Issues ◽  
Temporal Region ◽  
Skull Fractures ◽  
Autopsy Findings ◽  
Parietal Lobes ◽  
Event Reconstruction ◽  
Police Personnel ◽  
Autopsy Examination ◽  
Mass Fatality ◽  
The Brain

Introduction: Investigation into explosions is one of the major areas in forensic medicine and pathology. Medico legal issues associated with these deaths are diverse and forensic experts are often expected to make clarifications. Assistance of a methodical scientific investigation of such a death in evaluation of unanswered medico legal issues, of an autopsy of one of the victims of Easter Sunday explosions is discussed. Case history: The deceased was a 15-year-old girl who was participating in the Easter mass at St. Sebastian’s Church - Kattuwapaitya, Negombo, Sri Lanka when a suicide bomber blew himself up. The mother of the deceased noticed the deceased being rushed to the hospital. However, she was pronounced dead on admission. Pre-autopsy radiology revealed spherical shrapnel in the temporal region. At autopsy, the fatal injury was found on the head and a detailed study revealed skull fractures associated with penetration by 3 shrapnels. There was a keyhole lesion among the penetrations. Internal examination revealed an extensive dural tear underlying the compound fracture. The brain was grossly edematous with lacerations on the frontal and parietal lobes associated with localized subarachnoid hemorrhage. There were multiple underlying contusions on bilateral frontal white matter. Small subarachnoid haemorrhage was noted on the basal aspect of the brain. Discussion: Careful evaluation of the autopsy findings assisted in formulating the opinion scientifically on event reconstruction including the proximity of the victim to the epicenter of explosion and nature of explosive device, period of survival, mechanism of causation of skull fractures and the mechanism of death in addition to the cause of death. Conclusion: A forensic pathologist following a meticulous autopsy examination, along with a team of ballistic experts and specially trained police personnel play a pivotal task in analyzing a scene of explosion and an autopsy of a victim, in concluding the case and in bringing justice to all the victims and survivors of the catastrophe.

Favorable Response of Metastatic Adrenocortical Carcinoma to Etoposide, Adriamycin and Cisplatin (EAP) Chemotherapy. Report of two Cases

1992 ◽  
Vol 78 (5) ◽  
pp. 345-348 ◽  
Author(s):  
Alfredo Berruti ◽  
Massimo Terzolo ◽  
Piero Paccotti ◽  
Franco Veglio ◽  
Anna Pia ◽  
...  
Keyword(s):  
Adrenocortical Carcinoma ◽  
Partial Remission ◽  
Radical Surgery ◽  
Young Female ◽  
Debulking Surgery ◽  
Disease Free Interval ◽  
Free Interval ◽  
The Brain ◽  
Disease Free ◽  
Line Chemotherapy

The usefulness of non-specific chemotherapy for advanced adrenocortical carcinoma (ACC) Is controversial. We report on 2 young female patients (25 and 19 yr) who presented with a clinical picture of Cushing's syndrome due to histologically confirmed ACC. The first patient underwent radical surgery, but after a disease-free interval of 6 months a local recurrence was apparent. She was reoperated and treated with 6 courses of cisplatin and etoposide chemotherapy. Mitotane (8 g daily) was begun, but 2 months later debulking surgery was again performed. A second-line chemotherapy with the etoposide, adriamycin, cisplatin (EAP) scheme attained a partial remission lasting 7 months, then metastatic spread to the brain led to death of the patient. The survival time was 30 months. The second patient underwent radical surgery and adjuvant mitotane (4 g daily), but multiple lung and mediastinal metastases were diagnosed after an interval of 29 months. Chemotherapy with the EAP regimen (6 courses) without interrupting mitotane attained a partial remission lasting 21+ months. We suggest that the EAP scheme is active in advanced ACC and that Its association with mitotane is feasible.

scholarly journals Mesenchymal Chondrosarcoma of the Brain with Metastasis: A Case Report with Literature Review

2020 ◽  
Vol 11 (02) ◽  
pp. 344-348
Author(s):  
Sandeep Bhardwaj ◽  
Ashish Sharma ◽  
Akangsha Sharma
Keyword(s):  
Left Lung ◽  
Lumbar Vertebrae ◽  
Lateral Wall ◽  
Mesenchymal Chondrosarcoma ◽  
Radical Excision ◽  
Temporal Region ◽  
Ct Guided ◽  
Dismal Prognosis ◽  
Extraskeletal Mesenchymal Chondrosarcoma ◽  
The Brain

AbstractMesenchymal chondrosarcoma of the brain is one of the rarest tumors with dismal prognosis. A 26-year-old man presented with headache, vomiting, and diplopia. On evaluation, a moderately enhancing extra-axial lesion was seen in right temporal region involving right greater wing of sphenoid, adjacent right maxillary sinus, and lateral wall of right orbit. Patient underwent magnetic resonance imaging of the spine and computed tomography (CT) of the chest for possible metastasis which showed lesion in lumbar vertebrae and left lung. Patient was planned for CT-guided lung biopsy which proved inconclusive. The patient was further planned for craniotomy and underwent craniotomy with microscopic excision of the mass. Histoimmunochemistry was suggestive of extraskeletal mesenchymal chondrosarcoma. Mesenchymal chondrosarcoma of the brain is highly aggressive tumors which are difficult to differentiate radiologically. Radical excision followed by chemoradiotherapy is optimal treatment of choice.

Obsessive Musical Hallucinations in a Schizophrenia Patient: Psychopathological and fMRI Characteristics

CNS Spectrums ◽  
2011 ◽  
Vol 16 (7) ◽  
pp. 153-156 ◽  
Author(s):  
Maya Bleich-Cohen ◽  
Talma Hendler ◽  
Artashes Pashinian ◽  
Sarit Faragian ◽  
Michael Poyurovsky
Keyword(s):  
Schizophrenia Patient ◽  
Auditory Hallucinations ◽  
Functional Magnetic Resonance ◽  
Resonance Imaging ◽  
Obsessive Compulsive ◽  
Obsessive Compulsive Symptoms ◽  
Compulsive Disorder ◽  
Imaging Characteristics ◽  
Clinically Significant ◽  
The Brain

AbstractObsessive-compulsive symptoms (OCS) are relatively common and clinically significant phenomena in schizophrenia patients, suggesting the existence of a separate schizo-obsessive subgroup of the disorder. Although a majority of schizo-obsessive patients have typical ego-dystonic OCS, a meaningful proportion exhibits diagnostically challenging psychopathological phenomena, psychotic in content and obsessive in form. We report the clinical and functional magnetic resonance imaging characteristics of a schizophrenia patient who developed auditory hallucinations with musical content and obsessive in form. We suggest that “obsessive musical hallucinations”, that integrate both psychotic and obsessive-compulsive disorder (OCD)-related features, may be mediated by the brain networks believed to be involved in OCD and in auditory musical hallucinations.

scholarly journals Optic perineuritis secondary to hyaluronic acid injections: a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yanjun Hu ◽  
Yingjun Wang ◽  
Yuhua Tong
Keyword(s):  
Hyaluronic Acid ◽  
Oral Prednisolone ◽  
Young Female ◽  
Blurred Vision ◽  
Visual Field Examination ◽  
Case Presentation ◽  
Administration Method ◽  
The Right ◽  
Optic Discs ◽  
The Brain

Abstract Background Although a safe, excellent administration method for hyaluronic acid derivatives has been documented; improper injections can lead to devastating and irreversible consequences. Here, we present the first known case of optic perineuritis caused by hyaluronic acid. Case presentation A young female experienced sudden orbital pain in the right eye after receiving hyaluronic acid injections to the eyebrows. She presented to the eye clinic two weeks later, after developing blurred vision in the right eye. Visual acuity was reduced significantly in the right eye. Automated visual field examination showed defects in both eyes. Fundus examination revealed bilateral swelling of optic discs. Magnetic resonance imaging of the brain demonstrated bilateral perineural enhancement consistent with optic perineuritis. The patient was treated with retrobulbar injection of hyaluronidase and oral prednisolone. Her vision improved with treatment. Conclusions The prognosis for visual outcomes in patients with optic perineuritis is generally excellent. However, a poor prognosis is associated with delays to the initiation of treatment. Recognizing this condition is important, and treatment with corticosteroids should be initiated early.

scholarly journals A Case of Complex Partial Seizures Presenting as Acute and Transient Psychotic Disorder

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Sadia Sultan ◽  
Ebtihaj Omar Fallata
Keyword(s):  
Psychotic Disorder ◽  
Aggressive Behaviour ◽  
Financial Constraints ◽  
Temporal Region ◽  
Partial Seizures ◽  
Impaired Consciousness ◽  
Complex Partial Seizures ◽  
High Clinical Suspicion ◽  
Oral Olanzapine ◽  
The Brain

Introduction. Complex partial seizures are focal (CPS) (i.e., start in one area of the brain) and associated with impairment in consciousness. Most of them arise in the temporal region and are characterized by aura, impaired consciousness, and automatisms. CPS that arise in temporal region are most often misdiagnosed as primary psychiatric illness. Case Report. A 25-year-old male presented with fluctuations in consciousness, aggressive behaviour, hallucination, and delusions of grandeur lasting a few hours. He was diagnosed with acute and transient psychotic disorder according to ICD10 criteria and was treated with intramuscular haloperidol 10mg BID followed by oral olanzapine 10mg. Computed tomography of brain and electroencephalogram were normal. After 15 days he presented again to the outpatient department with complaints of aggressive behaviour and sensory misinterpretations. Video electroencephalogram was recommended, which was not done due to financial constraints. The diagnosis was reconsidered and he was started on oral carbamazepine due to high clinical suspicion, of complex partial seizures, in spite of lack of EEG evidence. He responded well to antiepileptic and symptom remission has maintained well. Conclusion. Patients presenting with psychosis need careful diagnostic evaluation for other possibilities.

scholarly journals Isolated medial longitudinal fasciculus syndrome: Review of imaging, anatomy, pathophysiology and differential diagnosis

2017 ◽  
Vol 31 (1) ◽  
pp. 95-99 ◽  
Author(s):  
Puneet S Kochar ◽  
Yogesh Kumar ◽  
Pranav Sharma ◽  
Vikash Kumar ◽  
Nishant Gupta ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Eye Movements ◽  
Brain Stem ◽  
Medial Longitudinal Fasciculus ◽  
Rare Occurrence ◽  
Comprehensive Review ◽  
Fiber Tracts ◽  
Imaging Characteristics ◽  
The Brain

Isolated medial longitudinal fasciculus (MLF) syndrome due to infarction limited only to the midbrain is a rare occurrence. The MLF are a group of fiber tracts located in the paramedian area of the midbrain and pons. They control horizontal eye movements by interconnecting oculomotor and abducens nuclei in the brain stem. Such small infarcts can easily be overlooked by young neuroradiologists and trainees. In this review, we discuss the clinical and imaging characteristics, comprehensive review of the anatomy, pathophysiology, and differential diagnosis.

scholarly journals Familial Retinal Arteriolar Tortuosity with Acute Hippocampal Infarction

2017 ◽  
Vol 8 (1) ◽  
pp. 185-189 ◽  
Author(s):  
Tae Hee Kim ◽  
Sonia Lee ◽  
Su Jin Lim
Keyword(s):  
Past History ◽  
Brain Magnetic Resonance Imaging ◽  
Transient Global Amnesia ◽  
Subcortical White Matter ◽  
Blurred Vision ◽  
Retinal Arterioles ◽  
History Of ◽  
Global Amnesia ◽  
The Brain ◽  
Retinal Arteriolar

Purpose: To report a case of familial retinal arteriolar tortuosity with acute hippocampal infarction. Method: Single-patient case report. Results: A 50-year-old woman presented with blurred vision and was found to have cataract, retinal hemorrhages, and tortuous retinal arterioles in both eyes. Similar findings of tortuous retinal arterioles were observed in her daughter and son. In her past history of 6 years prior to the visit, she had been diagnosed with transient global amnesia after brain magnetic resonance imaging, which showed hippocampal infarction and multiple chronic ischemic lesions in the periventricular and subcortical white matter. Conclusion: Familial retinal arteriolar tortuosity is known to affect the retinal vessels only. To our knowledge, this is the first report of ischemic injury to the brain in a patient with familial retinal arteriolar tortuosity.

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