scholarly journals Chronic Skull Base Erosion from Temporomandibular Joint Disease Causes Generalized Seizure and Profound Lactic Acidosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Mark A. Dobish ◽  
David A. Wyler ◽  
Christopher J. Farrell ◽  
Hermandeep S. Dhami ◽  
Victor M. Romo ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Skull Base ◽  
Temporomandibular Joint ◽  
Case Series ◽  
Type A ◽  
Oxidative Capacity ◽  
Joint Disease ◽  
Rare Presentation ◽  
Cellular Energy ◽  
Ph Range

This report displays a rare presentation of lactic acidosis in the setting of status epilepticus (SE). The differential diagnosis of lactic acidosis is broad and typically originates from states of shock; however, this report highlights an alternative and rare etiology, SE, due to chronic skull base erosion from temporomandibular joint (TMJ) disease. Lactic acidosis is defined by a pH below 7.35 in the setting of lactate values greater than 5 mmol/L. Two broad classifications of lactic acidosis exist: a type A lactic acidosis which stems from global or localized tissue hypoxia or a type B lactic acidosis which occurs once mitochondrial oxidative capacity is unable to match glucose metabolism. SE is an example of a type A lactic acidosis in which oxygen delivery is unable to meet increased cellular energy requirements. This report is consistent with a prior case series that consists of five patients experiencing generalized tonic-clonic (GTC) seizures and lactic acidosis. These patients presented with a pH range of 6.8-7.41 and lactate range of 3.8-22.4 mmol/L. Although severe lactic acidosis following GTC has been described, this is the first report in the literature of chronic skull base erosion from TMJ disease causing SE.

TMJ imaging: more pictures, less talk

2011 ◽  
Vol 2 (4) ◽  
pp. 172-182 ◽  
Author(s):  
Jimmy Makdissi de C Williams
Keyword(s):  
Rheumatoid Arthritis ◽  
Skull Base ◽  
Temporomandibular Joint ◽  
Temporal Bone ◽  
Mandibular Condyle ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Number Of Factors ◽  
Muscles Of Mastication ◽  
Anatomical Area

The temporomandibular joint (TMJ) is a complex anatomical area consisting of the mandibular condyle and the temporal bone of the skull base. It comes under the influence of a number of factors including the muscles of mastication, teeth, occlusion and the contralateral joint and thus there exists a spectrum of conditions. Internal derangement and degenerative joint disease remain the most common although there are a range of other less frequently occurring conditions such as rheumatoid arthritis, trauma and ankylosis.

scholarly journals Using pCO2 Gap in the Differential Diagnosis of Hyperlactatemia Outside the Context of Sepsis: A Physiological Review and Case Series

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Petr Waldauf ◽  
Katerina Jiroutkova ◽  
Frantisek Duska
Keyword(s):  
Cardiac Output ◽  
Lactic Acidosis ◽  
Critically Ill ◽  
Case Reports ◽  
Case Series ◽  
Type A ◽  
Physiological Data ◽  
Type B ◽  
Central Venous ◽  
Content Difference

Introduction. There is an inverse relationship between cardiac output and the central venous-arterial difference of partial pressures of carbon dioxide (pCO2 gap), and pCO2 gap has been used to guide early resuscitation of septic shock. It can be hypothesized that pCO2 gap can be used outside the context of sepsis to distinguish type A and type B lactic acidosis and thereby avoid unnecessary fluid resuscitation in patients with high lactate, but without organ hypoperfusion. Methods. We performed a structured review of the literature enlightening the physiological background. Next, we retrospectively selected a series of case reports of nonseptic critically ill patients with elevated lactate, in whom both arterial and central venous blood gases were simultaneously measured and the diagnosis of either type A or type B hyperlactataemia was conclusively known. In these cases, we calculated venous-arterial CO2 and O2 content differences and pCO2 gap. Results. Based on available physiological data, pCO2 can be considered as an acceptable surrogate of venous-arterial CO2 content difference, and it should better reflect cardiac output than central venous saturation or indices based on venous-arterial O2 content difference. In our case report of nonseptic patients, we observed that if global hypoperfusion was present (i.e., in type A lactic acidosis), pCO2 gap was elevated (>1 kPa), whilst in the absence of it (i.e., in type B lactic acidosis), pCO2 gap was low (<0.5 kPa). Conclusion. Physiological rationale and a small case series are consistent with the hypothesis that low pCO2 gap in nonseptic critically ill is suggestive of the absence of tissue hypoperfusion, mandating the search for the cause of type B lactic acidosis rather than administration of fluids or other drugs aimed at increasing cardiac output.

scholarly journals Pigmented Villonodular Synovitis of the Temporomandibular Joint with Skull Base Extension: A Retrospective Case Series

2021 ◽  
Author(s):  
Qiang He ◽  
Xin Zan ◽  
Fei Chen ◽  
Chao You ◽  
Jianguo Xu
Keyword(s):  
Skull Base ◽  
Temporomandibular Joint ◽  
Case Series ◽  
Pigmented Villonodular Synovitis ◽  
Biological Behavior ◽  
Villonodular Synovitis ◽  
Retrospective Case ◽  
Excellent Outcome ◽  
Base Extension ◽  
Pigmented Villonodular

Abstract Background: Pigmented villonodular synovitis (PVNS) of the temporomandibular joint (TMJ) with skull base extension is a rare entity. Here, we summarize the clinical features, treatments, and outcomes of PVNS of the TMJ with skull base extension in a large case series. Methods: We reviewed the clinical information relating to patients diagnosed with PVNS of the TMJ with skull base extension information of patients in our center between 2011 and 2020. Results: We reviewed 10 patients (4 males and 6 females). All cases had presented with a unilateral lesion extending the middle skull base. PVNS of the TMJ with skull base extension occurred on the left side in 6 patients (60%) and on the right side in 4 patients (40%). Of the 10 patients, pain and mass were the most prevalent symptoms. All patients received surgery and no recurrence was seen after 35.90±25.35 months follow-up. Conclusion: Despite destructive biological behavior, surgery can achieve an excellent outcome for patients with PVNS of the TMJ with skull base extension. An en bloc resection may prevent recurrence and provide long-term relief. Radiotherapy may be reserved for subtotal excision and recurrent lesions but require further investigation.

Complications after Proton Beam Therapy to Skull Base Tumors: Case Series

2019 ◽  
Author(s):  
Gustavo Rangel ◽  
Mostafa Shahein ◽  
Thiago Felicio ◽  
Guilhermo Malave ◽  
Nyall London ◽  
...  
Keyword(s):  
Skull Base ◽  
Proton Beam ◽  
Case Series ◽  
Proton Beam Therapy ◽  
Skull Base Tumors

Comprehensive Approach to Treatment of Pediatric Skull Base Lesions: A Case Series

2020 ◽  
Author(s):  
Craig Miller ◽  
Alizabeth Weber ◽  
Kate Carroll ◽  
Neeraja Konuthula ◽  
Abdullah Feroze ◽  
...  
Keyword(s):  
Skull Base ◽  
Case Series ◽  
Comprehensive Approach ◽  
Skull Base Lesions

Immuno-biological Assessments of Temporomandibular Joint Disease in Patients with Immune-mediated Rheumatic Conditions. A cross sectional study of 273 cases

2018 ◽  
Vol 68 (12) ◽  
pp. 2987-2991
Author(s):  
Cristina Iordache ◽  
Bogdan Vascu ◽  
Eugen Ancuta ◽  
Rodica Chirieac ◽  
Cristina Pomirleanu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Psoriatic Arthritis ◽  
Temporomandibular Joint ◽  
Final Analysis ◽  
Cross Sectional Study ◽  
Joint Disease ◽  
Sectional Study ◽  
Cross Sectional ◽  
Immune Parameters ◽  
Immune Mediated

Temporomandibular joint (TMJ) is commonly involved in various immune-mediated rheumatic disorders accounting for significant disability and impaired quality of life. The aim of our study was to assess inflammatory and immune parameters in patients with TMJ arthritis related to rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to identify potential relation with severity and dysfunction of TMJ pathology. We performed a cross-sectional study in a cohort of 433 consecutive RA, 32 JIA, 258 AS, and 103 PsA. Only patients presenting with clinically significant TMJ involvement (273) related to their rheumatic condition were included in the final analysis. TMJ involvement is traditionally described in chronic inflammatory rheumatic disorders, particularly in patients with higher levels of inflammation as detected in rheumatoid arthritis and psoriatic arthritis. Disease activity and severity, as well as biological and positive serological assessments (rheumatoid factor, anti-cyclic citrullinated peptide, IL-1) remain significant determinants of the severity of TMJ arthritis.

scholarly journals First experience with augmented reality neuronavigation in endoscopic assisted midline skull base pathologies in children

2021 ◽  
Author(s):  
Valentina Pennacchietti ◽  
Katharina Stoelzel ◽  
Anna Tietze ◽  
Erwin Lankes ◽  
Andreas Schaumann ◽  
...  
Keyword(s):  
Augmented Reality ◽  
Skull Base ◽  
Skull Base Surgery ◽  
Morphological Variability ◽  
Case Series ◽  
Relevant Information ◽  
Navigation Systems ◽  
Postoperative Mri ◽  
The Mean ◽  
Clinical Conditions

Abstract Introduction Endoscopic skull base approaches are broadly used in modern neurosurgery. The support of neuronavigation can help to effectively target the lesion avoiding complications. In children, endoscopic-assisted skull base surgery in combination with navigation systems becomes even more important because of the morphological variability and rare diseases affecting the sellar and parasellar regions. This paper aims to analyze our first experience on augmented reality navigation in endoscopic skull base surgery in a pediatric case series. Patients and methods A retrospective review identified seventeen endoscopic-assisted endonasal or transoral procedures performed in an interdisciplinary setting in a period between October 2011 and May 2020. In all the cases, the surgical target was a lesion in the sellar or parasellar region. Clinical conditions, MRI appearance, intraoperative conditions, postoperative MRI, possible complications, and outcomes were analyzed. Results The mean age of our patients was 14.5 ± 2.4 years. The diagnosis varied, but craniopharyngiomas (31.2%) were mostly represented. AR navigation was experienced to be very helpful for effectively targeting the lesion and defining the intraoperative extension of the pathology. In 65% of the oncologic cases, a radical removal was proven in postoperative MRI. The mean follow-up was 89 ± 79 months. There were no deaths in our series. No long-term complications were registered; two cerebrospinal fluid (CSF) fistulas and a secondary abscess required further surgery. Conclusion The implementation of augmented reality to endoscopic-assisted neuronavigated procedures within the skull base was feasible and did provide relevant information directly in the endoscopic field of view and was experienced to be useful in the pediatric cases, where anatomical variability and rarity of the pathologies make surgery more challenging.

scholarly journals Clinical Presentation, Management, and Prognosis of Pseudogout in Joint Arthroplasty: A Retrospective Cohort Study

2019 ◽  
Vol 4 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Merit P. George ◽  
Floranne C. Ernste ◽  
Aaron Tande ◽  
Douglas Osmon ◽  
Tad Mabry ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Medical Center ◽  
Case Reports ◽  
Joint Infection ◽  
Case Series ◽  
Calcium Pyrophosphate ◽  
Degenerative Joint Disease ◽  
Joint Disease ◽  
Antibiotic Overuse ◽  
Concomitant Infection

Abstract. Introduction: Calcium pyrophosphate deposition disease (CPPD), or pseudogout, is rare in prosthetic joints, but can mimic prosthetic joint infection (PJI) according to case reports. The purpose of this case series is to describe the demographics, presentation, management, and outcomes of a cohort of these patients seen at our academic medical center.Methods: Patients with post-implant pseudogout, who were evaluated at our medical center between January 1, 2000 and June 30, 2016, were identified from our EHR. Data pertaining to demographics, presentation, management, and outcomes were abstracted, and patients were categorized into two groups based on presence of concomitant infection along with positive CPDD findings in synovial fluid.Results: 22 patients were included. 90.9% of cases involved a TKA. The most common indication for arthroplasty was degenerative joint disease. Only four patients had a history of previous gout or pseudogout, three of which belonged to the group with no evidence of concomitant joint infection. Clinical features for patients without concomitant infection included pain (100%), swelling at the joint (88.9%), redness (33.3%), fever (22.2%), and decreased range of motion (100%). 45.5% of patients received antibiotics prior to joint aspiration (44.4% of patients with negative synovial fluid cultures, 46.2% of patients with concomitant infection).Conclusion: Our study suggests similar clinical presentation between post-implant pseudogout and PJI. Among patients with pseudogout as well as in those with PJI, the first dose of antibiotics should not be given before sampling for synovial culture. Unfortunately, many patients receive antibiotics prior to culture ascertainment, which raises concern for antibiotic overuse.

Pipeline Embolization Device for treatment of high cervical and skull base carotid artery dissections: clinical case series

2015 ◽  
Vol 8 (7) ◽  
pp. 722-728 ◽  
Author(s):  
Grzegorz Brzezicki ◽  
Dennis J Rivet ◽  
John Reavey-Cantwell
Keyword(s):  
Skull Base ◽  
Treatment Option ◽  
Case Series ◽  
Endovascular Intervention ◽  
Long Term Results ◽  
Complete Revascularization ◽  
Intraoperative Complication ◽  
Pipeline Embolization Device ◽  
High Cervical

BackgroundMost cervical dissections are treated with anticoagulation or antiplatelet agents with very good results; however, some patients may benefit from endovascular intervention. High cervical and skull base dissections are often more challenging to treat because of the distal location and tortuous anatomy. The Pipeline Embolization Device (PED) may be a reasonable treatment option for this indication.ObjectivesTo report a case series of patients treated with the PED for high cervical and skull base dissections, focusing on their presentation, indications for treatment, dissection revascularization success, and pseudoaneurysm obliteration evaluated by imaging, and to review available pertinent literature.MethodsWe retrospectively reviewed all cases of high cervical and skull base dissections treated with a PED at our institution. Patient clinical characteristics, presentation, procedural and follow-up imaging, and clinical course were analyzed to evaluate for procedure complications, dissection revascularization success, pseudoaneurysm obliteration, and clinical outcome.ResultsThis is a retrospective case series including 11 patients with 13 carotid dissections treated in our center. There were nine traumatic and four spontaneous dissections. The most common presentation was cerebrovascular accident/transient ischemic attack (CVA/TIA; 5 patients) and headache/face pain (4 patients). Eleven dissections were associated with pseudoaneurysms. Three patients failed medical management with anticoagulation, although flow-limiting stenosis was the main indication for endovascular intervention. Up to three PEDs per vessel were deployed. Angioplasty was used in 10 cases. Complete revascularization (<10% residual stenosis) was achieved in 91% of vessels and 50% of pseudoaneurysms were completely or near completely obliterated immediately after PED(s) deployment. Proximal iatrogenic dissection was the only intraoperative complication. Follow-up imaging was available for nine treated vessels and demonstrated patent PEDs without significant in-stent stenosis up to 9 months after intervention. 75% of pseudoaneurysms were completely obliterated at follow-up. One PED partially collapsed but had no neurological consequences. There were no new CVA/TIAs.ConclusionsOur initial experience with treatment of high cervical and skull base dissections with the PED appears to show that this technique may be a safe and viable treatment option. However, long-term results are needed to fully evaluate the efficacy of such treatment.

scholarly journals Intra-articular injection of botulinum toxin type A for shoulder pain in glenohumeral osteoarthritis: a case series summary and review of the literature

2018 ◽  
Vol Volume 11 ◽  
pp. 1239-1245 ◽  
Author(s):  
Nicoletta Cinone ◽  
Sara Letizia ◽  
Luigi Santoro ◽  
Michele Gravina ◽  
Loredana Amoruso ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Shoulder Pain ◽  
Botulinum Toxin Type A ◽  
Case Series ◽  
Type A ◽  
Botulinum Toxin Type ◽  
Review Of The Literature ◽  
Glenohumeral Osteoarthritis
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