scholarly journals Case Report: Ulcerative Colitis with Multiple Dural Venous Thrombosis

2021 ◽  
pp. 504-509
Author(s):  
Safia Mohamud ◽  
Mosunmola Oyawusi ◽  
Roger Weir ◽  
Richard M. Millis ◽  
Ozra Dehkordi
Keyword(s):  
Ulcerative Colitis ◽  
Magnetic Resonance ◽  
Vital Signs ◽  
Memory Loss ◽  
Lower Abdominal Pain ◽  
Neurological Status ◽  
Sudden Onset ◽  
University Hospital ◽  
History Of ◽  
Sound Sensitivity

<b>Background</b> Cerebral sinus vein thrombosis (CVT) is a rare but serious complication associated with ulcerative colitis (UC), an idiopathic autoimmune inflammatory disease of the gastrointestinal tract. Management approaches for CVT remain unclear but may include anticoagulation and surgical thrombectomy. Herein, we report a case of a 23-year-old male who developed CVT with a history of UC. The patient was presented to Howard University Hospital when he slipped and fell. On arrival at the hospital, he complained of a headache with an aching sensation, associated with light/sound sensitivity. The patient had a history of uncontrolled UC. He had positive bloody diarrhea, lower abdominal pain, but denied any other neurological deficit. Computed tomography of the head showed left frontoparietal lobe hypodensities. Neurological exam was nonfocal. Vital signs were within normal range, but the patient experienced some memory loss and personality changes. Subsequent diagnosis of CVT was made with magnetic resonance angiography and magnetic resonance venography. Immediate treatment with low-molecular-weight intravenous heparin (18 IU/kg) was introduced. His UC was managed with methylprednisolone (60 mg IV daily), proton pump inhibitors, mesalamine, ciprofloxacin, and metronidazole. His condition gradually improved. On discharge, he was prescribed prednisone, azathioprine for his UC, levetiracetam for seizure, and warfarin with an INR goal of 2–3. In conclusion, the sudden onset and/or acute worsening of neurological status such as headache and mental confusion in a patient with UC should alert the treating physician about the possibility of CVT so that timely intervention could be employed to prevent disabling and potentially lethal sequelae of this disease.

Torsion of a parasitic leiomyoma: a rare but important differential in women presenting with lower abdominal pain

2021 ◽  
Vol 14 (1) ◽  
pp. e232797
Author(s):  
Clemmie Stebbings ◽  
Ahmed Latif ◽  
Janakan Gnananandan
Keyword(s):  
Abdominal Pain ◽  
Iliac Fossa ◽  
Lower Abdominal Pain ◽  
Sudden Onset ◽  
Greater Omentum ◽  
Caribbean Woman ◽  
History Of ◽  
Right Iliac Fossa Pain ◽  
The Right ◽  
Fat Stranding

A 39-year-old multiparous Afro-Caribbean woman attended the emergency department with sudden-onset severe right iliac fossa pain. Her inflammatory markers were mildly elevated. Computerised tomography of the abdomen demonstrated features of fat stranding in the right iliac fossa suspicious of acute appendicitis. The scan also noted uterine leiomyomas. The patient was taken to theatre for an emergency diagnostic laparoscopy where her appendix was found to be macroscopically normal. A necrotic heavily calcified parasitic leiomyoma was seen in the right adnexa, free of the uterus and adherent to the greater omentum on a long torted pedicle. The parasitic leiomyoma was successfully removed piecemeal laparoscopically. Complications of leiomyomas, namely, torsion and necrosis, are important differentials in women presenting with sudden-onset lower abdominal pain. A history of sudden-onset severe lower abdominal pain with a background of known leiomyoma should prompt the clerking surgeon to consider a complication of leiomyoma as part of the differential diagnoses.

scholarly journals The Peculiar Case Of Diplopia

2020 ◽  
Vol 02 (12) ◽  
pp. 10-14
Author(s):  
Dr Anubhav Chauhan ◽  
◽  
Dr Deepak Kumar Sharma ◽  
Dr Pankaj Kumar Thakur ◽  
Dr Anchit Wap a ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Memory Loss ◽  
Resonance Imaging ◽  
Probable Case ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Case Diagnosis ◽  
Peculiar Case ◽  
Binocular Diplopia

A nineteen - year - old female presented with a history of binocular diplopia for one week. She had a history of headache, seizures, and memory loss. Magnetic Resonance Imaging (MRI) of brain revealed subependymal astrocytoma as the cause of her symptoms. Our pa tient was a probable case of tuberous sclerosis complex (TSC). Diplopia was the presenting sign in this case diagnosis.

scholarly journals Elevated serum CA 19-9 level, combined with D-dimer, could detect the presence of ruptured ovarian endometriosis

2020 ◽  
Author(s):  
Ting Shuang ◽  
Lanbo Zhao ◽  
Kailu Zhang ◽  
Yiran Wang ◽  
Panyue Yin ◽  
...  
Keyword(s):  
Elevated Serum ◽  
Lower Abdominal Pain ◽  
Clinical Importance ◽  
Sudden Onset ◽  
Ca 125 ◽  
Ovarian Endometriosis ◽  
Non Invasive ◽  
History Of ◽  
Auc Value ◽  
D Dimer

Abstract Background: Ovarian endometriosis (OE) is a common type of endometrioma, which is a benign disease of gynecology. For the diagnosis of OE, ultrasonography is a very effective and straightforward. OE rupture is rare, and there is still a lack of a non-invasive and effective method for diagnosis. Elevated serum CA19-9 or CA-125 levels are typically applied as biomarkers for malignancy, besides, the CA-125 and CA19-9 levels have been recommended as a useful marker for the diagnosis of endometriosis. We aimed to clarify the clinical importance of serum CA19-9, CA-125 level, and plasma D-dimer (D-D) for detecting spontaneously ruptured ovarian endometriosis.Results: Among the 21 patients of rupture OE, 16 with a history of detected pelvic cysts, 19 claimed sudden onset of lower abdominal pain, however, only 6 patients detected fluid accumulation in the cul-de-sac by ultrasound. For the serological investigation, the serum CA19-9 was significantly elevated in the ruptured OE group (343.09±367.67 U/ml vs. 36.84±40.01U/ml, P<0.0001). D-D was also abnormally elevated in the ruptured OE group (3.39±4.90 mg/L vs. 0.43 ± 0.29 mg/L, P <0.0001). The AUC value for the combined CA19-9 and D-D was 0.975 (95% CI, 0.939 -0.993), with the highest specificity of 96.69, and sensitivity of 85.71.Conclusion: The combination of serum CA19-9 and plasma D-D levels could serve as an effective biomarker to identify patients with spontaneously ruptured ovarian endometriosis pre-operatively in the context of clinical assessment.

scholarly journals Shift-to-shift handoff: A comparison between two methods of conveying essential information in a University Hospital in North-eastern Italy

2014 ◽  
Vol 3 (5) ◽  
pp. 39 ◽  
Author(s):  
Rosanna Quattrin ◽  
Laura Calligaris ◽  
Carla Londero ◽  
Enrico Zalateu ◽  
Silvio Brusaferro
Keyword(s):  
Wound Care ◽  
Vital Signs ◽  
Neurological Status ◽  
University Hospital ◽  
Study Phase ◽  
Second Phase ◽  
Essential Information ◽  
Hospital Units ◽  
North Eastern ◽  
Before And After

Objective: The present study focuses on effective communication among nurses during a shift-to-shift handoff. Methods: The completeness of data conveyed during the shift-to-shift handoff was compared in two University Hospital Units, before and after the introduction of a pre-printed sheet summarizing the most important patients’ piece of information. The study took place in a University Hospital located in North-eastern Italy. In the first study phase 111 single patient’s handoffs were analyzed: 52 in Operative Unit 1 (OU1) and 59 in Operative Unit 1 (OU2). In the second phase of the study 39 handoffs were considered: 19 in the OU1 and 20 in the OU2. The intervention consisted of the introduction of a pre-printed semi structured sheet summarizing the patients’ information. The main outcome measures were the patients’ information written on the form and the data available for consultation by colleagues on the next work shift. Results: The four categories of items that most significantly increased after the introduction of the semi-structured form were respectively: neurological status, vital signs, pain assessment and wound care. However, none of the items that showed a reduction in citation, both for single OU and overall, were significant. Conclusions: This study shows how the introduction of a pre-printed form forces the operators to hold in consideration important critical values of a patient, thus bettering the quality and safety of the handoffs.

scholarly journals P.118 Trigemino-cardiac reflex: a case report of intra-operative asystole in response to manipulation of the temporalis muscle

2018 ◽  
Vol 45 (s2) ◽  
pp. S47-S47
Author(s):  
H Shakil ◽  
A Wang ◽  
K Reddy
Keyword(s):  
Trigeminal Nerve ◽  
Cranial Nerves ◽  
Vital Signs ◽  
Sudden Onset ◽  
Motor Nucleus ◽  
Skull Base Tumor ◽  
Temporalis Muscle ◽  
Medline Search ◽  
Sensory Nucleus ◽  
History Of

Background: The trigemino-cardiac reflex (TCR) is a sudden onset of bradycardia, hypotension, apnea or gastric hypermotility during stimulation of the trigeminal nerve. Methods: We conducted a MEDLINE search for surgical cases of TCR and herein describe a case seen recently at our institution. Results: A 60 year-old female underwent a left orbitozygomatic craniotomy for resection of a skull-base tumor. Pre-operative anesthesia evaluation was unremarkable and negative for a history of cardiovascular disease. Intra-operatively, retraction with moderate force of the temporalis muscle consistently produced asystole. Cessation of retraction resulted in immediate return of sinus rhythm. Otherwise, intra-operative heart rate was 60-90 BPM. Post-operatively, vital signs and clinical course were unremarkable. The patient experienced a similar phenomenon during an operation 6 years earlier, when manipulation of tumor near cranial nerves IX/X resulted in bradycardia. TCR is the result of a polysynaptic brainstem network involving the afferent trigeminal sensory nucleus, the reticular formation, and the efferent vagal motor nucleus. Conclusions: This is a case of exaggerated vagal response following manipulation of the temporalis muscle. Our report emphasizes the importance for neurosurgeons and anesthesiologists alike to be wary of TCR in order to avoid deleterious consequences when operating on structures associated with the trigeminal nerve.

scholarly journals Endometriosis Nodule Causing Spontaneous Haemoperitoneum in Pregnancy: A Case Report and Literature Review

2017 ◽  
Vol 2017 ◽  
pp. 1-3 ◽  
Author(s):  
Junaid Rafi ◽  
Geetha Mahindrakar ◽  
Debjani Mukhopadhyay
Keyword(s):  
Vital Signs ◽  
Lower Abdominal Pain ◽  
Rare Condition ◽  
Fetal Outcome ◽  
Sudden Onset ◽  
In Vitro Fertilisation ◽  
Abdominal Palpation ◽  
General Surgeons ◽  
In Pregnancy

Spontaneous haemoperitoneum in pregnancy (SHiP) due to endometriosis is a very rare condition and this is a case of a 41-year-old primigravida, who presented at 32 weeks with sudden onset of severe lower abdominal pain without any uterine activity. This was a dichorionic-diamniotic twin pregnancy, following in vitro fertilisation for subfertility secondary to severe endometriosis. On admission, pain score was eight, with ten being the maximum of the scale. The vital signs were stable. Abdominal palpation revealed generalised tenderness with no guarding or palpable contraction. There was no evidence of bleeding and the cervical os was closed on speculum examination. The cardiotocograph (CTG) was pathological and a plan was made to deliver the babies with emergency caesarean section. Intraoperatively, there was massive haemoperitoneum which was managed successfully with the involvement of multidisciplinary input from general surgeons and urologists with optimum maternal and fetal outcome.

Glioblastoma multiforme metastasis to the axis

2005 ◽  
Vol 102 (3) ◽  
pp. 540-542 ◽  
Author(s):  
Satoshi Utsuki ◽  
Satoshi Tanaka ◽  
Hidehiro Oka ◽  
Kazuhisa Iwamoto ◽  
Takao Sagiuchi ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Magnetic Resonance ◽  
Tumor Resection ◽  
Sudden Onset ◽  
Resonance Imaging ◽  
Content Type ◽  
Magnetic Resonance Studies ◽  
First Case ◽  
History Of ◽  
Multiple Bone Metastases

✓ Extracranial bone metastasis from glioblastoma multiforme (GBM) has rarely been reported in the literature, and most metastatic GBMs are multiple bone metastases. The authors describe the first case of a GBM with metastasis only to the axis. This 42-year-old man presented with a 2-month history of headache, nausea, vomiting, and disorientation. Magnetic resonance imaging demonstrated a right temporal tumor, which was diagnosed as a GBM based on tumor resection. The patient was treated using radiation (6000 cGy) and the intravenous administration of nimustine hydrochloride. Eighteen months thereafter, he experienced the sudden onset of neck pain. Magnetic resonance studies revealed a tumor in the axis that was diagnosed as GBM based on biopsy procedure.

scholarly journals Adult intussusception secondary to an appendiceal tumour in a patient with ulcerative colitis: a case report

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
M. G. Davey ◽  
E. T. Conlon ◽  
G. Forde ◽  
V. M. Byrnes ◽  
P. A. Carroll
Keyword(s):  
Ulcerative Colitis ◽  
Normal Mucosa ◽  
Right Hemicolectomy ◽  
Sudden Onset ◽  
Hepatic Flexure ◽  
Adult Intussusception ◽  
Low Grade ◽  
Appendiceal Tumour ◽  
History Of ◽  
Ileocecal Intussusception

Abstract Background Intussusception in adult patients is uncommon and appendiceal lead points are particularly rare. Case presentation We present the case of a 42-year-old male with a history of ulcerative colitis, presenting with sudden onset abdominal pain and bloody diarrhoea. Endoscopy revealed grossly normal mucosa in the descending colon with a congested polypoid mass in the proximal transverse colon. Computed tomography revealed ileocecal intussusception at the hepatic flexure. A right hemicolectomy was performed, where a grossly dilated appendix was noted, resected and sent for histopathological evaluation. Results revealed low-grade appendiceal mucinous neoplasm. Post-operatively, the patient remained symptom free, however required reintroduction of biologic therapy due to relapse of his ulcerative colitis 12 weeks later. Conclusion This case depicts a rare acute surgical presentation and reminds physicians and surgeons of the importance of ‘thinking outside the box’ in clinical practice.

scholarly journals Spontaneous ventral spinal epidural hematoma in a child: A case report and review of literature

2016 ◽  
Vol 07 (02) ◽  
pp. 297-299 ◽  
Author(s):  
Shailendra Ratre ◽  
Yadram Yadav ◽  
Sushma Choudhary ◽  
Vijay Parihar
Keyword(s):  
Epidural Hematoma ◽  
Neurological Status ◽  
Cord Compression ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Sensory Loss ◽  
Spinal Epidural Hematoma ◽  
Spontaneous Spinal Epidural Hematoma ◽  
History Of ◽  
Spinal Epidural

ABSTRACTSpontaneous spinal epidural hematoma is very uncommon cause of spinal cord compression. It is extremely rare in children and is mostly located in dorsal epidural space. Ventral spontaneous spinal epidural hematoma (SSEH) is even rarer, with only four previous reports in childrens. We are reporting fifth such case in a 14 year old male child. He presented with history of sudden onset weakness and sensory loss in both lower limbs with bladder bowel involvment since 15 days. There was no history of trauma or bleeding diasthesis. On clinical examination he had spastic paraplegia.Magnetic resonance imaging (MRI) of dorsal spine was suggestive of ventral spinal epidural hematoma extending from first to sixth dorsal vertebrae. Laminectomy of fourth and fifth dorsal vertebrae and complete evacuation of hematoma was done on the same day of admission. Postoperatively the neurological status was same.

Magnetic Resonance Imaging of Pseudo-impingement of Rotator Cuff with Strength Training

2019 ◽  
Vol 1 ◽  
pp. 2-6
Author(s):  
Asad Naqvi ◽  
Timothy Ariyanayagam ◽  
Mir Akber Ali ◽  
Akhila Rachakonda ◽  
Hema N. Choudur
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Rotator Cuff ◽  
Strength Training ◽  
Radiology Department ◽  
Resonance Imaging ◽  
Subacromial Space ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Training Exercises

Objective: The objective of this study was to outline a novel unique concept of secondary impingement of the muscles, myotendons, and tendons of the rotator cuff from hypertrophy as a result of strength training exercises. Methods: In this retrospective observational study, 58 patients were referred for an magnetic resonance imaging (MRI) by the orthopedic surgeon to the radiology department over a period of 1½ years. All patients gave a history of strength training exercises and presented with clinical features of rotator cuff impingement. Results: We identified features of hypertrophy of rotator cuff muscles, myotendons, and tendons in 12 of these 58 patients. This was the only abnormality on MRI. The hypertrophy of rotator cuff muscles and tendon bulk completely filling the subacromial space to the point of overfilling and resulting in secondary compressive features. Conclusion: Rotator cuff impingement is a common phenomenon that can occur with various inlet and outlet pathological conditions. However, rotator cuff impingement may also result from muscle and tendon hypertrophy from strength training regimens. Hypertrophy of the rotator cuff can result in overfilling of the subacromial space, leading to secondary impingement, which we have termed as “pseudo-impingement.”

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