scholarly journals Deciphering the Scream of Silence: Diagnostic Dilemma of Psychosis in Deaf Mute Patients- A Case Series

2020 ◽  
Vol 03 (01) ◽  
pp. 24-28
Author(s):  
Dinesh Kataria ◽  
Keyword(s):  
Case Series ◽  
Diagnostic Dilemma

Odontogenic Infections with Cutaneous Involvement in Children: a Case Series

Dental Update ◽  
2020 ◽  
Vol 47 (2) ◽  
pp. 144-148
Author(s):  
Joana Monteiro ◽  
Adèle Johnson ◽  
Pathanjali Kandiah ◽  
Prabhleen Anand ◽  
Stephen Fayle
Keyword(s):  
Case Series ◽  
Well Being ◽  
Skin Lesions ◽  
Diagnostic Dilemma ◽  
Odontogenic Infections ◽  
Cutaneous Involvement ◽  
Odontogenic Origin ◽  
Oral Symptoms ◽  
The Uk ◽  
Dental Professionals

Cutaneous involvement of dental sepsis is a rare occurrence in children. It often presents as a diagnostic dilemma, especially in the absence of oral symptoms, with initial presentation to non-dental professionals. This article discusses three cases of children presenting with cutaneous involvement of odontogenic origin to two paediatric dentistry departments in the UK. All cases had delayed presentations and were initially submitted to ineffective treatment, with significant impact on the children’s well-being. Final management included antibiotic therapy, drainage and extraction of the septic tooth. These three cases highlight the importance of considering a dental aetiology for localized inflammatory and purulent skin lesions of the mandible. Prompt diagnosis and early treatment are determinant for early resolution and avoidance of systemic or psychological complications. CPD/Clinical Relevance: This article discusses diagnosis and management of three different presentations of odontogenic sepsis with cutaneous involvement in children.

scholarly journals Tuberculous brain abscesses: Case series and review of literature

2011 ◽  
Vol 02 (02) ◽  
pp. 153-157 ◽  
Author(s):  
Sarala Menon ◽  
Renu Bharadwaj ◽  
A.S. Chowdhary ◽  
D.V. Kaundinya ◽  
D.A. Palande
Keyword(s):  
Brain Abscess ◽  
Mr Spectroscopy ◽  
Case Series ◽  
Final Diagnosis ◽  
Diagnostic Dilemma ◽  
Proton Mr Spectroscopy ◽  
Microbiological Culture ◽  
Brain Abscesses ◽  
Tuberculous Brain Abscess

ABSTRACT Introduction: Tuberculous brain abscess (TBA) is a rare but serious condition. It resembles a pyogenic brain abscess clinically and radiologically and poses a problem in diagnosis and treatment. A final diagnosis is established by smear or culture demonstration of acid fast bacilli (AFB) within the abscess. Here, we report four such cases in our fiveyear study on brain abscesses, along with the different diagnostic modalities used. Materials and Methods: A total of 75 brain abscess pus specimens were collected during neurosurgery, either by burr hole or by craniotomy. These specimens were further subjected to Gram stain, Ziehl-Neelsen (ZN) stain, and conventional microbiological culture. Only those cases which showed presence of AFB on ZN stain along with the growth of Mycobacterium tuberculosis were considered as TBAs. Such TBA cases were further presented along with their In vitro Proton Magnetic Resonance (MR) Spectroscopic findings. Results: Of these four patients, three were males. Though this condition is more commonly seen in immunocompromised patients, three of the patients in this study were immunocompetent. All the four pus specimens showed presence of AFB in the ZN stain. Three of them grew M. tuberculosis as sole isolate. The fourth case was of concomitant tuberculous and pyogenic brain abscess. In vitro Proton MR spectroscopy of the pus specimens showed absence of multiple amino acids at 0.9 ppm, which was found to be hallmark of TBA. One patient died of four. Conclusions: TBA always poses a diagnostic dilemma. ZN stain and conventional microbiological culture for Mycobacteria always help to solve this dilemma. In vitro Proton MR Spectroscopy also seems to have the diagnostic utility.

scholarly journals Head and Neck Schwannomas: A Surgical Challenge—A Series of 5 Cases

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Ishtyaque Ansari ◽  
Ashfaque Ansari ◽  
Arjun Antony Graison ◽  
Anuradha J. Patil ◽  
Hitendra Joshi
Keyword(s):  
Brachial Plexus ◽  
Head And Neck ◽  
Case Series ◽  
Neck Region ◽  
Anatomical Location ◽  
Diagnostic Dilemma ◽  
Neurogenic Tumors ◽  
Peripheral Nerve Sheath Tumors ◽  
Formidable Challenge ◽  
Nerve Of Origin

Background. Schwannomas, also known as neurilemmomas, are benign peripheral nerve sheath tumors. They originate from any nerve covered with schwann cell sheath. Schwannomas constitute 25–45% of tumors of the head and neck. About 4% of head and neck schwannomas present as a sinonasal schwannoma. Brachial plexus schwannoma constitute only about 5% of schwannomas. Cervical vagal schwannomas constitute about 2–5% of neurogenic tumors. Methods. We present a case series of 5 patients of schwannomas, one arising from the maxillary branch of trigeminal nerve in the maxillary sinus, second arising from the brachial plexus, third arising from the cervical vagus, and two arising from cervical spinal nerves. Result. Complete extracapsular excision of the tumors was achieved by microneurosurgical technique with preservation of nerve of origin in all except one. Conclusion. Head and neck schwannoma though rare should be considered as a differential diagnosis of a unilateral slow growing mass in the head and neck region, particularly in an adult. Schwannomas are always a diagnostic dilemma as they are asymptomatic for long time, and histopathology is the gold standard for diagnosis. As a rule, treatment is surgical and dictated by the location of the tumor and nerve of origin. Due to its rarity, complex anatomical location and morbidity risk postexcision, they can pose a formidable challenge to surgeons. This study aims to describe the presentation, workup, surgical technique, and outcome.

scholarly journals Diagnostic Dilemma of Paraneoplastic Rheumatic Disorders: Case Series and Narrative Review

Cureus ◽  
2021 ◽  
Author(s):  
Youngmin Cho ◽  
Erik W Anderson ◽  
Sara J Guevara ◽  
Santiago J Miyara ◽  
Naomi Maria ◽  
...  
Keyword(s):  
Case Series ◽  
Narrative Review ◽  
Diagnostic Dilemma

scholarly journals UNILATERAL PROPTOSIS - A DIAGNOSTIC DILEMMA

2021 ◽  
Vol 71 (5) ◽  
pp. 1755-58
Author(s):  
Ubaid Ullah Yasin ◽  
Muhammad Amer Yaqub ◽  
Syed Abid Hassan Naqvi ◽  
Muhammad Shahid ◽  
Asad Habib ◽  
...  
Keyword(s):  
Correct Diagnosis ◽  
Tertiary Care ◽  
Case Series ◽  
Armed Forces ◽  
Care Hospital ◽  
Diagnostic Challenge ◽  
Chi Square ◽  
Diagnostic Dilemma ◽  
Radio Imaging ◽  
Unilateral Proptosis

Objective: To study epidemiology, presentation and management of cases with unilateral proptosis presenting at a tertiary care hospital. Study Design: Case series. Place and Duration of Study: Armed Forces Institute of Ophthalmology, Rawalpindi Pakistan, from Jan 2016 to Dec 2017. Methodology: Retrospective analysis of hospital record of patients with unilateral proptosis was carried out. Data was entered and analyzed in SPSS version 22. Chi square test was used for statistical analysis. Results: Thirty-three cases of unilateral proptosis with a mean age of 41.79 ± 3.87 years were included in the study. Pain was the most common association. Proptosis was mild in 42.4%, moderate in 48.5% and severe in 9.1% cases. In 61% cases, diagnosis was made on excisional or incisional biopsy and on the basis of radio imaging in 39% cases. Most common cause of proptosis found was pleomorphic adenoma (12%). Patients with axial and non-axial proptosis were 48.5% and 51.5% respectively. Fourteen cases (42.5%) were managed surgically and 2 cases (6%) were observed. Total of 22 cases (67%) improved after treatment, 8 cases (24%) went into remission, 2 (6%) deteriorated, and 1 (3%) died in the study period. Conclusion: Unilateral proptosis is a diagnostic challenge. Pertinent history taking and detail examination is the key, but associated signs or symptoms not always point towards correct diagnosis. Tissue biopsy provides a conclusive diagnosis especially where radio imaging is doubtful.

A case series of right atrial mass in neonates: a diagnostic dilemma

2019 ◽  
pp. 1-4
Author(s):  
Viraraghavan V. Ramaswamy ◽  
Vikram Kudumula ◽  
Bandiya Prathik ◽  
G. S. Sanghamitra ◽  
Nori Suryanarayana ◽  
...  
Keyword(s):  
Case Series ◽  
Right Atrial ◽  
Diagnostic Dilemma ◽  
Atrial Mass ◽  
Right Atrial Mass

Heparin Induced Thrombocytopenia; A Diagnostic Dilemma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4468-4468
Author(s):  
John L. Reagan ◽  
Samir Dalia ◽  
James N. Butera
Keyword(s):  
Conflicts Of Interest ◽  
Case Series ◽  
Serotonin Release ◽  
Pretest Probability ◽  
Thrombin Inhibitors ◽  
Bleeding Complications ◽  
Direct Thrombin Inhibitors ◽  
Retrospective Case ◽  
Diagnostic Dilemma ◽  
Heparin Induced Thrombocytopenia

Abstract Abstract 4468 Introduction The diagnosis of HIT can be challenging. Short of the serotonin release assay, which can be difficult to get in a timely manner, the 4T method developed by Lo et al., in conjunction with the HIT elisa assay (EIA), is the best established criteria for the rapid diagnosis of Heparin Induced Thrombocytopenia (HIT). We sought to determine how often the 4Ts were being applied at a large academic institution. In addition, we sought to understand the outcome of patients started on direct thrombin inhibitors (DTIs) who did not meet the 4T/EIA criteria for HIT. Methods A retrospective case series identified patients placed on DTI for HIT treatment from 10/2006 to 5/2008. The 4T pretest probability was then applied retrospectively. HIT EIA Ab testing, optical densities, duration of DTI treatment, and bleeding incidence were recorded. Liberal and modified conservative criteria from Lo et al.'s study were used to define patients with HIT. Overdiagnosis of HIT was then recorded based on the above criteria. Results 76 patients were included for analysis. The average age was 61.4 years. Based on the 4T pretest probability, 30 patients were classified as low risk, 37 intermediate risk, and 9 high risk for HIT. The average HIT OD for low, intermediate, and high pretest probability was 0.49, 1.17, and 2.05. 76% and 36% of patients treated with DTIs for HIT met the liberal and modified conservative HIT definitions, respectively. 18 patients (24%) did not meet liberal HIT criteria but remained on DTI treatment for 1 to 60 days. Cost of DTI overuse in this subset was $84,960. Cost of DTI use in patients who did not meet modified conservative criteria was $462,246. All 16 patients who developed bleeding complications fulfilled a liberal diagnosis of HIT while only 6 of these patients fulfilled the modified conservative definition of HIT. Conclusions 1) The 4T method for diagnosing HIT is not being applied to a large percentage of patients in a tertiary academic center. 2) There is an overdiagnosis of HIT regardless of definition criteria with 24% of patients treated for HIT not meeting the liberal definition while 64% of patients did not meet the modified conservative definition. This overdiagnosis has both a significant monetary and morbidity cost. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Infant Botulism in the Very Young Neonate: A Case Series

2017 ◽  
Vol 07 (03) ◽  
pp. e163-e166 ◽  
Author(s):  
Laura Jackson ◽  
Suneeta Madan-Khetarpal ◽  
Monica Naik ◽  
Marian Michaels ◽  
Melissa Riley
Keyword(s):  
Neonatal Intensive Care ◽  
Early Recognition ◽  
Delayed Diagnosis ◽  
Case Series ◽  
The United States ◽  
Diagnostic Dilemma ◽  
Infant Botulism ◽  
Critically Ill Neonates ◽  
Prolonged Hospital ◽  
Work Up

Background Though botulism is a rare disease overall, all infants younger than 1 year of age are at risk of contracting infant botulism, the most prevalent form reported in the United States. Nonetheless, infant botulism is frequently omitted from the differential diagnosis of the very young neonate exclusively due to age, and the diagnosis is often only considered secondarily after a costly and prolonged work up is undertaken. Delayed diagnosis can lead not only to unnecessary testing but also to prolonged hospital stay and increased morbidity. Case This case series highlights three critically ill neonates, all younger than 30 days, who presented to our neonatal intensive care unit and were eventually diagnosed with infant botulism. The initial diagnostic dilemma is described for each of these patients and highlights the importance of early recognition of the main symptoms, in addition to consideration of important potential coinciding conditions.

scholarly journals Spasm of the near reflex: a common diagnostic dilemma?

2021 ◽  
Vol 14 (4) ◽  
pp. 541-546
Author(s):  
Eleni Papageorgiou ◽  
◽  
Eftychia Kapsalaki ◽  
Efthymios Dardiotis ◽  
Asimina Mataftsi ◽  
...  
Keyword(s):  
Case Series ◽  
Diagnostic Procedures ◽  
Psychological Disorder ◽  
Eye Drops ◽  
Retrospective Case ◽  
Blurred Vision ◽  
Diagnostic Dilemma ◽  
Number Of Patients ◽  
Near Reflex ◽  
Screen Use

AIM: To report the clinical characteristics and diagnostic procedures used in patients with spasm of the near reflex (SNR), in order to present common investigation strategies and diagnostic pitfalls. METHODS: Retrospective case series of twenty-two patients, mainly children, with SNR or accommodation spasm (AS). AS was diagnosed on the basis of blurred vision and a difference of >2 dioptres between manifest and cycloplegic retinoscopy. If esotropia and miosis were present, the patients were diagnosed with SNR. All patients underwent visual acuity testing, orthoptic evaluation, assessment of refraction before and after cycloplegia, and dilated fundoscopy. Additional diagnostic investigations, such as neuroimaging, lumbar puncture (LP), electrophysiology and blood tests, were also recorded. Screen use among children was assessed in hours per day. RESULTS: There were 19 female and 3 male patients (age range 7-33y, median=10y). Seventeen patients had AS and 5 patients had SNR, with episodic blurry vision and headaches being the most common symptoms. Brain neuroimaging was performed in six patients (27%), although only one had a history of brain trauma. Two of those patients underwent visual evoked potentials and three also underwent LP and received intravenous steroid therapy. The majority of patients (90%) reported prolonged daily screen time (>2h/d), and in 55% of cases there were concurrent social problems or psychological triggers. Treatment consisted of careful explanation of the condition, atropine 1% eye drops and full cycloplegic correction by means of bifocal glasses. CONCLUSION: The diagnosis of SNR and AS may be challenging, because symptoms are usually intermittent and nonspecific, and a large number of patients are often subjected to redundant and potentially time-consuming examinations and treatment, that may exaggerate the underlying psychological disorder. Hence, detailed clinical testing and assessment of psychosocial profile is necessary, in order to avoid unnecessary investigations. Neuroimaging should be performed only in selected cases. Finally, due to prolonged screen use SNR and AS may become more frequent in the future.

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