Death Resulting from Pneumocephalus Complicating Endoscopic Food Bolus Retrieval in a Patient with Eosinophilic Esophagitis

Amy K. Fuhs; Joseph A. Prahlow

doi:10.23907/2016.066

Death Resulting from Pneumocephalus Complicating Endoscopic Food Bolus Retrieval in a Patient with Eosinophilic Esophagitis

Academic Forensic Pathology ◽

10.23907/2016.066 ◽

2016 ◽

Vol 6 (4) ◽

pp. 703-708 ◽

Cited By ~ 1

Author(s):

Amy K. Fuhs ◽

Joseph A. Prahlow

Keyword(s):

Eosinophilic Esophagitis ◽

Rare Complication ◽

Flexible Endoscopy ◽

Brain Parenchyma ◽

Esophageal Mucosa ◽

Food Bolus ◽

Patient Death ◽

Injury Death ◽

Computed Tomography Scanning ◽

The Brain

Pneumocephalus is a rare complication of esophagogastroduodenoscopy (EGD), but existing literature does not discuss pneumocephalus surrounding endoscopic food bolus retrieval. We present a death involving pneumocephalus complicating endoscopic food removal from the esophagus. A 40-year-old man presented with dysphagia and suprasternal discomfort 12 hours following chicken ingestion. On flexible endoscopy, chicken was visualized in the distal esophagus. After successful retrieval, a mucosal laceration was noted where the chicken had been lodged. He was unarousable following the procedure and was emergently transported to a hospital, where computed tomography scanning showed pneumocephalus. He was later declared brain dead. The case was referred for medicolegal autopsy. The brain was examined first, revealing rare air bubbles within meningeal vessels and numerous, diffuse petechiae-like hemorrhages within the brain parenchyma. The esophageal mucosa had focal discoloration and a partial thickness laceration; microscopic examination revealed eosinophilic esophagitis. Eosinophilic esophagitis is a known risk factor for food bolus impaction and should be suspected in such patients. Pneumocephalus is a rare possible complication of EGD for food bolus retrieval. In patients unresponsive after endoscopy, radiographic detection of potential pneumocephalus should be encouraged to enable timely therapy and improved outcomes, or to supplement autopsy in the event of patient death. Forensic pathologists should understand that pneumocephalus is a potential mechanism of injury/death in patients experiencing esophageal trauma, including injury incurred during EGD.

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Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

Case Reports in Medicine ◽

10.1155/2014/673189 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 8

Author(s):

Natalia Vernon ◽

Divyanshu Mohananey ◽

Ehsan Ghetmiri ◽

Gisoo Ghaffari

Keyword(s):

Eosinophilic Esophagitis ◽

Esophageal Perforation ◽

Rare Complication ◽

Esophageal Mucosa ◽

Esophageal Rupture ◽

Food Impaction ◽

Initial Manifestation ◽

Esophageal Lumen ◽

History Of ◽

Esophageal Dysfunction

Eosinophilic esophagitis (EoE) is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave’s syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children) and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

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Delayed Intraventricular Hemorrhage following a Ventriculoperitoneal Shunt Placement: Exploring the Surgical Anatomy of a Rare Complication

Case Reports in Medicine ◽

10.1155/2017/3953248 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Ioannis N. Mavridis ◽

Athanassios Mitropoulos ◽

Constantinos Mantas ◽

Aikaterini Karagianni ◽

Konstantinos Vlachos

Keyword(s):

Ventriculoperitoneal Shunt ◽

Intraventricular Hemorrhage ◽

Vascular Malformations ◽

Rare Complication ◽

Normal Pressure ◽

Brain Parenchyma ◽

Surgical Anatomy ◽

Neurosurgical Procedures ◽

Potential Factors ◽

The Brain

Ventriculoperitoneal shunt (VPS) placement is one of the commoner neurosurgical procedures worldwide. The purpose of this article is to report a case of delayed intraventricular hemorrhage (IVH) following a VPS and to review the literature regarding anatomic factors that could potentially explain this rare complication. A 78-year-old man with normal pressure hydrocephalus, who underwent an uneventful right VPS placement, suffered from a catastrophic isolated IVH five days later. The reported cases of delayed intracerebral hemorrhage (ICH) following VPS are rare and those with IVH are even rarer. Potential factors of surgical anatomy that could cause delayed ICH/IVH following a VPS procedure include erosion of vasculature by catheter cannulation, multiple attempts at perforation, puncture of the choroid plexus, improper placement of the tubing within the brain parenchyma, VPS system revision, venous infarction, vascular malformations, head trauma, and brain tumors. Other causes include generalized convulsion, VPS system malfunction, increased intracranial or blood pressure, sudden intracranial hypotension, and bleeding disorders. According to the current literature, our case is the first reported delayed isolated IVH after a VPS placement so far. Neurosurgeons should be aware of the delayed ICH/IVH as a rare, potentially fatal complication of VPS, as well as of its risk factors.

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Macrophages and microglia: the cerberus of glioblastoma

Acta Neuropathologica Communications ◽

10.1186/s40478-021-01156-z ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Alice Buonfiglioli ◽

Dolores Hambardzumyan

Keyword(s):

Tumor Cells ◽

Innate Immune System ◽

Tumor Heterogeneity ◽

Expression Profiles ◽

Brain Parenchyma ◽

Innate Immune ◽

Malignant Growth ◽

Neoplastic Cells ◽

Functional Roles ◽

The Brain

AbstractGlioblastoma (GBM) is the most aggressive and deadliest of the primary brain tumors, characterized by malignant growth, invasion into the brain parenchyma, and resistance to therapy. GBM is a heterogeneous disease characterized by high degrees of both inter- and intra-tumor heterogeneity. Another layer of complexity arises from the unique brain microenvironment in which GBM develops and grows. The GBM microenvironment consists of neoplastic and non-neoplastic cells. The most abundant non-neoplastic cells are those of the innate immune system, called tumor-associated macrophages (TAMs). TAMs constitute up to 40% of the tumor mass and consist of both brain-resident microglia and bone marrow-derived myeloid cells from the periphery. Although genetically stable, TAMs can change their expression profiles based upon the signals that they receive from tumor cells; therefore, heterogeneity in GBM creates heterogeneity in TAMs. By interacting with tumor cells and with the other non-neoplastic cells in the tumor microenvironment, TAMs promote tumor progression. Here, we review the origin, heterogeneity, and functional roles of TAMs. In addition, we discuss the prospects of therapeutically targeting TAMs alone or in combination with standard or newly-emerging GBM targeting therapies.

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Practical application of synthetic head models in real ballistic cases

International Journal of Legal Medicine ◽

10.1007/s00414-021-02671-3 ◽

2021 ◽

Author(s):

F. Riva ◽

T. Fracasso ◽

A. Guerra ◽

P. Genet

Keyword(s):

Soft Tissues ◽

Spherical Model ◽

Brain Parenchyma ◽

Human Bone ◽

Shape Model ◽

The Difference ◽

Open Shape ◽

The Brain ◽

Synthetic Models ◽

Representative Material

AbstractIn shooting crimes, ballistics tests are often recommended in order to reproduce the wound characteristics of the involved persons. For this purpose, several “simulants” can be used. However, despite the efforts in the research of “surrogates” in the field of forensic ballistic, the development of synthetic models needs still to be improved through a validation process based on specific real caseworks. This study has been triggered by the findings observed during the autopsy performed on two victims killed in the same shooting incident, with similar wounding characteristics; namely two retained head shots with ricochet against the interior wall of the skull; both projectiles have been recovered during the autopsies after migration in the brain parenchyma. The thickness of the different tissues and structures along the bullets trajectories as well as the incident angles between the bullets paths and the skull walls have been measured and reproduced during the assemblage of the synthetic head models. Two different types of models (“open shape” and “spherical”) have been assembled using leather, polyurethane and gelatine to simulate respectively skin, bone and soft tissues. Six shots have been performed in total. The results of the models have been compared to the findings of post-mortem computed tomography (PMCT) and the autopsy findings.Out of the six shots, two perforated the models and four were retained. When the projectile was retained, the use of both models allowed reproducing the wounds characteristics observed on both victims in terms of penetration and ricochet behaviour. However, the projectiles recovered from the models showed less deformation than the bullets collected during the autopsies. The “open shape” model allowed a better controlling on the shooting parameters than the “spherical” model. Finally, the difference in bullet deformation could be caused by the choice of the bone simulant, which might under-represent either the strength or the density of the human bone. In our opinion, it would be worth to develop a new, more representative material for ballistic which simulates the human bone.

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Primary Cranial Vault Lymphoma Extending between Subcutaneous Tissue and Brain Parenchyma without Skull Destruction after Mild Head Trauma: A Case Report and Literature Review

Case Reports in Oncology ◽

10.1159/000516272 ◽

2021 ◽

pp. 1118-1123

Author(s):

Kengo Setta ◽

Takaaki Beppu ◽

Yuichi Sato ◽

Hiroaki Saura ◽

Junichi Nomura ◽

...

Keyword(s):

Tumor Cells ◽

Head Trauma ◽

Dura Mater ◽

Subcutaneous Tissue ◽

Bone Destruction ◽

B Cell Lymphoma ◽

Brain Parenchyma ◽

Skin Tumor ◽

Cranial Vault ◽

The Brain

Malignant lymphoma of the head rarely arises outside of the brain parenchyma as primary cranial vault lymphoma (PCVL). A case of PCVL that invaded from subcutaneous tissue into the brain, passing through the skull, and occurred after mild head trauma is reported along with a review of the literature. The patient was a 75-year-old man with decreased activity. One month before his visit to our hospital, he bruised the left frontal area of his head. Magnetic resonance imaging showed homogeneously enhanced tumors with contrast media in the subcutaneous tissue corresponding to the head impact area and the cerebral parenchyma, but no obvious abnormal findings in the skull. A biopsy with craniotomy was performed under general anesthesia. The pathological diagnosis was diffuse large B-cell lymphoma. On histological examination, tumor cells grew aggressively under the skin. Tumor cells invaded along the emissary vein into the external table without remarkable bone destruction and extended across the skull through the Haversian canals in the diploe. Tumor cells were found only at the perivascular areas in the dura mater and extended into the brain parenchyma. Considering the history of head trauma and the neuroimaging and histological findings, the PCVL in the present case arose primarily under the skin, passed though the skull and dura mater, and invaded along vessels and reached the brain.

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Microglial Function and Regulation during Development, Homeostasis and Alzheimer’s Disease

Cells ◽

10.3390/cells10040957 ◽

2021 ◽

Vol 10 (4) ◽

pp. 957

Author(s):

Brad T. Casali ◽

Erin G. Reed-Geaghan

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Immune Cells ◽

Expression Patterns ◽

Brain Parenchyma ◽

Primary Role ◽

And Function ◽

Inflammatory Milieu ◽

The Brain ◽

Homeostatic State

Microglia are the resident immune cells of the brain, deriving from yolk sac progenitors that populate the brain parenchyma during development. During development and homeostasis, microglia play critical roles in synaptogenesis and synaptic plasticity, in addition to their primary role as immune sentinels. In aging and neurodegenerative diseases generally, and Alzheimer’s disease (AD) specifically, microglial function is altered in ways that significantly diverge from their homeostatic state, inducing a more detrimental inflammatory environment. In this review, we discuss the receptors, signaling, regulation and gene expression patterns of microglia that mediate their phenotype and function contributing to the inflammatory milieu of the AD brain, as well as strategies that target microglia to ameliorate the onset, progression and symptoms of AD.

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CTNI-03. IMAGING FEATURES OF LEPTOMENINGEAL METASTASES OF NON-SMALL CELL LUNG CANCER: A SINGLE-CENTER REAL-WORLD STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa215.170 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii41-ii41

Author(s):

Junjie Zhen ◽

Lei Wen ◽

Shaoqun Li ◽

Mingyao Lai ◽

Changguo Shan ◽

...

Keyword(s):

Spinal Cord ◽

Type A ◽

Brain Parenchyma ◽

Imaging Features ◽

Type B ◽

Type D ◽

Mri Examination ◽

Mri Features ◽

Brain And Spinal Cord ◽

The Brain

Abstract BACKGROUND According to EANO-ESMO clinical practice guidelines, the MRI findings of LM are divided into 4 types, namely linear enhancement (type A), nodular enhancement (type B), linear combined with nodular enhancement (type C), and sign of hydrocephalus (type D). METHODS The MRI features of brain and spinal cord in patients diagnosed with NSCLC-LM in Guangdong Sanjiu Brain Hospital from 2010 until 2019 were investigated, and then were classified into 4 types. The imaging features were analyzed. RESULTS A total of 80 patients were enrolled in the study. The median age of the patients was 53.5 years old, and the median time from the initial diagnosis to the confirmed diagnosis of LM was 11.6 months. The results of enhanced MRI examination of the brain in 79 cases showed that the number of cases with enhancements of type A, B, C and D were 50 (63.3%), 0, 26 (32.9%) and 3 (3.8%), respectively, and that LM with metastases to the brain parenchyma was found in 42 cases (53.2%). The results of enhanced MRI examination of spinal cord in 59 cases showed that there were only enhancements of type A and C in 40 cases (67.8%) and 3 cases (5.0%), and no enhancement sign in the other 16 cases (27.2%). CONCLUSION MRI examination of brain and spinal cord will improve the detection rate of LM. The MRI features of NSCLC-LM in real world are mainly characterized by the linear enhancements of brain and spinal cord, followed by linear combined with nodular enhancement. The enhancements of type B and type D are rare in clinic. Almost half of the patients have LM and metastases to the brain parenchyma. Therefore, the differentiation of tumor metastases is needed to be paid attention to for the early diagnosis and the formulation of reasonable treatment plans.

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Selective growth of human melanoma cells in the brain parenchyma of nude mice

Melanoma Research ◽

10.1097/00008390-199610000-00003 ◽

1996 ◽

Vol 6 (5) ◽

pp. 363-371 ◽

Cited By ~ 13

Author(s):

T Fujimaki ◽

J E Price ◽

D Fan ◽

C D Bucana ◽

K Itoh ◽

...

Keyword(s):

Nude Mice ◽

Melanoma Cells ◽

Brain Parenchyma ◽

Human Melanoma ◽

Selective Growth ◽

Human Melanoma Cells ◽

The Brain

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Effects of endotoxin and dexamethasone on cerebral malaria in mice

Parasitology ◽

10.1017/s003118200006594x ◽

1995 ◽

Vol 111 (4) ◽

pp. 443-454 ◽

Cited By ~ 18

Author(s):

A. L. Neill ◽

N. H. Hunt

Keyword(s):

Cerebral Malaria ◽

Evans Blue ◽

Plasmodium Berghei ◽

Tumour Necrosis ◽

Brain Parenchyma ◽

Post Inoculation ◽

Cba Mice ◽

Cerebral Involvement ◽

The Brain ◽

Necrosis Factor

SUMMARYCBA/T6 and DBA/2J mice inoculated withPlasmodium bergheiANKA (PbA) develop cerebral involvement 6–8 days post-inoculation, from which the CBA mice almost invariably die and the DBA mice recover. Dexamethasone (DXM; 80 mg/kg) given to inoculated CBA mice twice, on day 3 and again within 48 h, reduced the cerebral symptoms and prevented death from cerebral malaria. Plasma tumour necrosis factor (TNF) levels, which increased at the time of the cerebral symptoms, were also reduced in these DXM-treated mice. Intravenously administered Evans Blue, a dye which binds to albumin, diffused extensively across the blood-brain barrier only during the period of cerebral symptoms, in proportion to the severity of the cerebral symptoms and the disease. In PbA-infected CBA mice, cerebral symptoms and the amount of Evans Blue diffusing into the brain tissue were both reduced by DXM treatment, but only if the steroid was given on day 3 and again within 48 h. Endotoxin injected intravascularly into PbA-infected DBA mice after day 5 resulted in an exaggeration of cerebral symptoms and death between days 6 and 9. Plasma TNF and the amount of Evans Blue in the brain parenchyma increased above normal levels in these mice. Endotoxin injections had only minor effects on the severity of the cerebral symptoms in PbA-infected CBA mice and did not cause the animals to die sooner.

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