scholarly journals Intracranial Ricocheting of Bullet from Anterior Clinoid Process

2008 ◽  
Vol 47 (171) ◽  
Author(s):  
Amit Agrawal ◽  
A Pratap ◽  
RK Rauniar ◽  
A Kumar ◽  
U Nepal
Keyword(s):  
Gunshot Wounds ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Occipital Region ◽  
Unique Case ◽  
Anterior Clinoid Process ◽  
X Ray ◽  
Left Behind

Gunshot wounds to the head are usually mortal injuries. We present a unique case of intracranial ricocheting of bullet without neurological deficits. Patient was treated conservatively with antibiotics for one week and prophylactic anticonvulsants for six weeks. Patient is doing well at six months follow up. Repeat X-ray skull showed that bullet was lying in the occipital region. It is recommended that deep seated bullets should be left behind as any attempt to remove that bullet may increase the morbidity and mortality. However close follow up of these patients is very important as these patients may come back with brain abscess.JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):145-146.

Gunshot Wounds to the Spine in Adolescents

Neurosurgery ◽  
2005 ◽  
Vol 57 (4) ◽  
pp. 748-752 ◽  
Author(s):  
Henry E. Aryan ◽  
Arun P. Amar ◽  
Burak M. Ozgur ◽  
Michael L. Levy
Keyword(s):  
Injury Severity ◽  
Spinal Injury ◽  
Gunshot Wounds ◽  
Dynamic Imaging ◽  
Neurological Deficits ◽  
Spinal Instability ◽  
Severity Of Injury ◽  
Bony Involvement ◽  
Cervical Injuries

ABSTRACT OBJECTIVE: The incidence of spinal instability after penetrating gunshot wounds to the spine in adolescents is unknown. We describe our experience over a 15-year period. METHODS: Hospital records were reviewed retrospectively. After injury and emergency care, patients were transferred to a rehabilitation facility. Examinations were completed using the American Spinal Injury Association and Frankel scales on admission, discharge, and 6 and 12 months after injury. Severity of injury was described by: 1) degree of neurological damage, 2) degree of preserved neurological function, and 3) presence of instability. RESULTS: Sixty patients were identified with a mean age 15.6 years (± 2.7 yr). Twelve patients had cervical, 31 thoracic, and 17 lumbosacral injuries. No operative treatments were used in their care. Thirty-four patients had complete neurological deficits. Mean acute hospitalization was 21.1 days (± 22.8 d), and mean rehabilitation stay was 86.3 days (± 48.9 d), for a total hospitalization of 107.4 days (± 65.9 d). At 1 year, 19 patients were ambulatory and 53 were autonomous. Despite the presence of bony involvement in all, no evidence of spinal instability was noted on follow-up dynamic imaging. Even in two patients with apparent two-column disruption, no instability was noted. At 1-year follow-up, significant (nonfunctional) improvement was noted in the neurological examination (P < 0.0001). Improvements were most notable in those patients with cervical injuries, followed by thoracic and lumbar injuries. CONCLUSION: After penetrating gunshot wounds to the spine, patients at 1-year follow-up examinations have evidence of significant, but nonfunctional, improvement. No evidence of spinal instability was noted in this study, and no surgical intervention was required.

scholarly journals FOREFOOT MYOPERICYTOMA: A CASE REPORTAND REVIEW OF THE LITERATURE

2021 ◽  
Vol 9 (4) ◽  
pp. 859-862
Author(s):  
Fahd Idarrha ◽  
Youness Aznague ◽  
Yassine Fathlkhir ◽  
Brahim Demnati ◽  
Abass Guedi Omar ◽  
...  
Keyword(s):  
Smooth Muscle Actin ◽  
Dorsal Surface ◽  
Growth Patterns ◽  
Malignant Neoplasms ◽  
Unique Case ◽  
X Ray ◽  
Painless Mass ◽  
The Right ◽  
Rare Group

Background:Myopericytoma (MPC) is term that describe a rare group of perivascular tumours of soft tissue and show a range of histological growth patterns. Only a few cases describing MPC have been reported. Aims: To document and investigate the clinical and histopathological characteristics and differential diagnosis of myopericytoma. Patients/methods: The present study reports a unique case of myopericytomas found in the 2nd and 3rd inter-toe spaces of a 54-year-old patient. Results: a 54 year old female patient, presents in our department for a painless mass on the dorsal surface of the right forefoot of progressive installation over 2 years.The mass was firm, non pulsatile and mobile, with no sign of inflammation, evolving in a context of conservation of the general state. The X-ray of the right forefoot did not reveal any notable bone abnormality. An MRI was subsequently performed, which objectified an infiltrating tumor mass of probable sarcomatous origin. The mass was excised surgically, and a pathological and immunohistochemical examination was performed afterward, the diagnosis of myopericytoma was confirmed. No recurrence was found in the follow-up of 12 months. Conclusions: MPC is a rare and mostly benign tumor that presents as spindle cells in a concentric perivascular growth model with an immunohistochemical staining positive for smooth muscle actin. Local recurrences and rarely metastases may occur in atypical and malignant neoplasms.

Cervical spine injury from gunshot wounds

2014 ◽  
Vol 21 (3) ◽  
pp. 442-449 ◽  
Author(s):  
Narlin Beaty ◽  
Justin Slavin ◽  
Cara Diaz ◽  
Kyle Zeleznick ◽  
David Ibrahimi ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neurological Deficit ◽  
Neurological Outcome ◽  
Treatment Algorithm ◽  
Gunshot Wounds ◽  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Cervical Instability ◽  
Cord Injury

Object Gunshot wounds (GSWs) to the cervical spine have been examined in a limited number of case series, and operative management of this traumatic disease has been sparsely discussed. The current literature supports and the authors hypothesize that patients without neurological deficit need neither surgical fusion nor decompression. Patients with GSWs and neurological deficits, however, pose a greater management challenge. The authors have compiled the experience of the R Adams Cowley Shock Trauma Center in Baltimore, Maryland, over the past 12 years, creating the largest series of such injuries, with a total number of 40 civilian patients needing neurosurgical evaluation. The current analysis examines presenting bone injury, surgical indication, presenting neurological examination, and neurological outcome. In this study, the authors characterize the incidence, severity, and recovery potential of cervical GSWs. The rate of unstable fractures requiring surgical intervention is documented. A detailed discussion of surgical indications with a treatment algorithm for cervical instability is offered. Methods A total of 144 cervical GSWs were retrospectively reviewed. Of these injuries, 40 had documented neurological deficits. No neurosurgical consultation was requested for patients without deficit. Epidemiological and clinical information was collected on patients with neurological deficit, including age, sex, timing, indication, type of surgery, initial examination after resuscitation, follow-up examination, and imaging data. Results Twenty-eight patients (70%) presented with complete neurological deficits and 12 patients (30%) presented with incomplete injuries. Fourteen (35%) of the 40 patients underwent neurosurgical intervention. Twelve patients (30%) required intervention for cervical instability. Seven patients required internal fixation involving 4 anterior fusions, 2 posterior fusions, and 1 combined approach. Five patients were managed with halo immobilization. Two patients underwent decompression alone for neurological deterioration and persistent compressive injury, both of whom experienced marked neurological recovery. Follow-up was obtained in 92% of cases. Three patients undergoing stabilization converted at least 1 American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade and the remaining operative cases experienced small ASIA motor score improvement. Eighteen patients underwent inpatient MRI. No patient suffered complications or neurological deterioration related to retained metal. Three of 28 patients presenting with AIS Grade A improved to Grade B. For those 12 patients with incomplete injury, 1 improved from AIS Grade C to D, and 3 improved from Grade D to E. Conclusions Spinal cord injury from GSWs often results in severe neurological deficits. In this series, 30% of these patients with deficits required intervention for instability. This is the first series that thoroughly documents AIS improvement in this patient population. Adherence to the proposed treatment algorithm may optimize neurological outcome and spine stability.

scholarly journals Migrating Souvenir Bullet: The Management Dilemma

2021 ◽  
pp. 097275312096649
Author(s):  
Srikant Kumar Swain ◽  
Rajnish Kumar Arora ◽  
Radhe Shyam Mittal
Keyword(s):  
Neurological Deficit ◽  
Temporal Region ◽  
Occipital Region ◽  
Mortality And Morbidity ◽  
X Ray ◽  
Cerebral Trauma ◽  
Long Term Follow Up ◽  
The Right

The cranio-cerebral trauma following gunshot injuries has high mortality and morbidity, with 66% to 90% victims dying before reaching hospital and only half of those treated in hospital surviving. However, in case of most salvageable patients, the question which poses dilemma to treating physicians is the decision as to when and why remove the retained missile. A 21-year-old man was observing a gunfight in the street from his balcony. Suddenly something struck his forehead and there was a small amount of bleeding toward the medial end of his left eyebrow. He had moderate headache and dizziness. Because of nonresolution of headache over seven days he was hospitalized and underwent X ray of the skull and CT of the head, which showed a retained metallic bullet in left inferior parieto-occipital region without any significant hemorrhage. As there was no neurological deficit or meningeal signs, he was managed conservatively. His symptoms improved gradually within next week and he was discharged home. His most recent follow-up was 28 months since injury and imaging showed migration of the bullet to the right inferior temporal region. As he was completely asymptomatic throughout, no intervention was offered. However, long-term follow-up for potential complications of migration, hydrocephalus, and abscess formation is advisable.

Early Diagnosis and Treatment of Chylous Mesenteric Cysts

2020 ◽  
Vol 86 (9) ◽  
pp. 1205-1207
Author(s):  
Gwyneth A. Sullivan ◽  
Nicholas J. Skertich ◽  
Keith W. Millikan ◽  
Mary Beth Madonna ◽  
Ami N. Shah
Keyword(s):  
Bowel Obstruction ◽  
Mesenteric Artery ◽  
Family Counseling ◽  
Unique Case ◽  
Elective Resection ◽  
Short Gut Syndrome ◽  
Postoperative Surveillance ◽  
X Ray ◽  
Mesenteric Cysts

Mesenteric cysts are benign congenital cysts typically discovered incidentally during abdominal explorations for other reasons. When feasible, they should be excised to prevent recurrence, bowel obstruction or volvulus, and resulting complications. We present a unique case of an infant, diagnosed prenatally by ultrasound with possible bowel obstruction, found to have micro and macro chylous mesenteric cysts. Although initially asymptomatic with normal abdominal x-ray and discharged on day of life 2, the parents were taught how to recognize symptoms of bowel obstruction. He presented at 1 month with obstructive symptoms, was confirmed to have large mesenteric cystic structures on ultrasound, and was immediately taken to the operating room. Due to the extensive number of cysts and intimate involvement of the largest cyst with the superior mesenteric artery, he was treated with partial excision and observation since resection may have resulted in short gut syndrome. Given a prenatal ultrasound suggestive of mesenteric cysts, we recommend abdominal imaging at birth with close follow-up until the appropriate time for elective resection. When disease is extensive precluding full enucleation and resection, we advocate for enucleation in combination with unroofing of as many cysts as possible followed by postoperative surveillance ultrasounds and family counseling.

scholarly journals Can break-dance break your neck? C1/C2 luxation with a combined dens fracture without neurological deficits in an 11-year old boy after a break-dance performance

2015 ◽  
Vol 5 (3) ◽  
Author(s):  
Athanasios K. Petridis ◽  
Adrian Kinzel ◽  
Klaus Blaeser ◽  
Joost Thissen ◽  
Homajoun Maslehaty ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Stable Condition ◽  
Rare Condition ◽  
Neurological Dysfunction ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
Extreme Sports ◽  
X Ray ◽  
Dens Fracture

Atlantoaxial dislocation in children is a very rare condition. We present the case of a dislocation happened during a break-dance maneuver. The purpose of this report is describing dangers of break-dancing and discussing the treatment we chose. The patient was followed up until 12 months after surgery. Magnetic resonance imaging and computed tomography of the cervical spine were evaluated. Translaminar fixation of C1/C2 had been performed after manual reposition under X-ray illumination. After a 12-month follow-up, the patient shows a stable condition without neurological dysfunction. He is not allowed to perform any extreme sports.

Electron Microscopy of Human Gallstones

1971 ◽  
Vol 29 ◽  
pp. 296-297
Author(s):  
C. Wolpers ◽  
R. Blaschke
Keyword(s):  
Electron Microscopy ◽  
Room Temperature ◽  
Bile Pigment ◽  
X Ray Diffraction ◽  
Triclinic Crystal System ◽  
X Ray ◽  
Follow Up Study ◽  
Infra Red ◽  
Main Components

Scanning microscopy was used to study the surface of human gallstones and the surface of fractures. The specimens were obtained by operation, washed with water, dried at room temperature and shadowcasted with carbon and aluminum. Most of the specimens belong to patients from a series of X-ray follow-up study, examined during the last twenty years. So it was possible to evaluate approximately the age of these gallstones and to get information on the intensity of growing and solving.Cholesterol, a group of bile pigment substances and different salts of calcium, are the main components of human gallstones. By X-ray diffraction technique, infra-red spectroscopy and by chemical analysis it was demonstrated that all three components can be found in any gallstone. In the presence of water cholesterol crystallizes in pane-like plates of the triclinic crystal system.

Congenital Syphilis Simulating Bone Neoplasm in 2-Month Old Infant – Case Report

2017 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Case Report ◽  
Congenital Syphilis ◽  
Eosinophilic Granuloma ◽  
Osteolytic Lesion ◽  
Lower Limbs ◽  
Upper Body ◽  
Elective Cesarean Section ◽  
Distal Fibula ◽  
X Ray

Introduction: Congenital Syphilis (CS) occurs through the transplacental transmission of Treponema pallidum in inadequately treated or non-treated pregnant women, and is capable of severe consequences such as miscarriage, preterm birth, congenital disease and/or neonatal death. CS has been showing an increasing incidence worldwide, with an increase of 208% from 2009 to 2015 in Brazil. Case report: 2-month old infant receives care in emergency service due to edema of right lower limb with pain in mobilization. X-ray with osteolytic lesion in distal fibula. Infant was sent to the Pediatrics Oncology clinic. Perinatal data: 7 prenatal appointments, negative serology at 10 and 30 weeks of gestation. End of pregnancy tests were not examined and tests for mother’s hospital admission were not requested. Mother undergone elective cesarean section at 38 weeks without complications. During the pediatric oncologist appointment, patient showed erythematous-squamous lesions in neck and other scar-like lesions in upper body. A new X-ray of lower limbs showed lesions in right fibula with periosteal reaction associated with aggressive osteolytic lesion compromising distal diaphysis, with cortical bone rupture and signs of pathological fracture, suggestive of eosinophilic granuloma. She was hospitalized for a lesion biopsy. Laboratory tests: hematocrit: 23.1 / hemoglobin 7.7 / leukocytes 10,130 (without left deviation) / platelets 638,000 / Negative Cytomegalovirus IgG and IgM and Toxoplasmosis IgG and IgM / VDRL 1:128. Congenital syphilis diagnosis with skin lesions, bone alterations and anemia. Lumbar puncture: glucose 55 / total proteins 26 / VDRL non reagent / 13 leukocytes (8% neutrophils; 84% monomorphonuclear; 8% macrophages) and 160 erythrocytes / negative VDRL and culture. X-ray of other long bones, ophthalmological evaluation and abdominal ultrasound without alterations. Patient was hospitalized for 14 days for treatment with Ceftriaxone 100mg/kg/day, due to the lack of Crystalline Penicillin in the hospital. She is now under outpatient follow-up. Discussion: CS is responsible for high rates of morbidity and mortality. The ongoing increase of cases of this pathology reflects a severe health issue and indicates failures in policies for the prevention of sexually transmitted diseases, with inadequate follow-up of prenatal and maternity protocols.

Lingual Dystonia Treated with Botulinum Toxin - A Case Report

1970 ◽  
Vol 24 (2) ◽  
pp. 75-78
Author(s):  
MA Hayee ◽  
QD Mohammad ◽  
H Rahman ◽  
M Hakim ◽  
SM Kibria
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
X Ray ◽  
Medical College ◽  
Lingual Dystonia ◽  
History Of ◽  
Chest X Ray

A 42-year-old female presented in Neurology Department of Sir Salimullah Medical College with gradually worsening difficulty in talking and eating for the last four months. Examination revealed dystonic tongue, macerated lips due to continuous drooling of saliva and aspirated lungs. She had no history of taking antiparkinsonian, neuroleptics or any other drugs causing dystonia. Chest X-ray revealed aspiration pneumonia corrected later by antibiotics. She was treated with botulinum toxin type-A. Twenty units of toxin was injected in six sites of the tongue. The dystonic tongue became normal by 24 hours. Subsequent 16 weeks follow up showed very good result and the patient now can talk and eat normally. (J Bangladesh Coll Phys Surg 2006; 24: 75-78)

Microsurgical resection of medullary cavernoma via the olivary zone by the retrosigmoid supracondylar approach

2019 ◽  
Vol 1 (2) ◽  
pp. V7
Author(s):  
Ken Matsushima ◽  
Michihiro Kohno ◽  
Helmut Bertalanffy
Keyword(s):  
Cavernous Malformation ◽  
Cleavage Plane ◽  
Foramen Magnum ◽  
Senior Author ◽  
Neurological Deficits ◽  
Lateral Part ◽  
Sitting Position ◽  
Brainstem Cavernoma ◽  
Microsurgical Resection

Microsurgical resection of the medullary cavernoma is rare, comprising less than 15% of more than 250 surgeries of brainstem cavernoma performed by the senior author (H.B.).1 This video demonstrates a case of a cavernous malformation inside the lateral part of the medulla, which was surgically treated via the olivary zone by the retrosigmoid supracondylar approach in a half-sitting position. Osseous drilling of the lateral foramen magnum provided wide exposure of the cerebellomedullary cistern around the olive.2,3 The lesion was completely dissected at the appropriate cleavage plane from the normal parenchyma. The patient developed no new neurological deficits and had no recurrence during 3 years of follow-up after the operation.The video can be found here: https://youtu.be/7i7SccS5HmU.

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