scholarly journals Therapeutic Challenge in a Case of Recent Onset Refractory Cluster Seizures

2021 ◽  
Vol 11 (2) ◽  
pp. 146-149
Author(s):  
Sachin Sureshbabu ◽  
Muralikrishnan Veleri Padmanabhan ◽  
Jacob Alappat ◽  
Smilu Mohanlal ◽  
Sujith Janardhanan ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Focal Cortical Dysplasia ◽  
Acute Onset ◽  
Recent Onset ◽  
Positron Emission ◽  
Class 1 ◽  
Cluster Seizures ◽  
Tomography Data ◽  
Left Middle

A dilemma exists in context to the timing of surgery in a case presenting with explosive onset seizures secondary to a focal cortical dysplasia (FCD). This case report highlights the challenges faced in the management of a 4-year-old child with recent onset cluster seizures refractory to anti-epileptic drugs. A 4-year-old girl presented with an acute onset of cluster seizures (up to 32 in a day), semiologically characterized by tonic upper limb extension and laughter lasting for few seconds with no response to multiple anti-epileptic drugs. The clinical, electrographic, neuroimaging and interictal positron emission tomography data were concordant and consistent with a left middle frontal gyrus dysplasia which was successfully resected under electrocorticographic guidance. Patient is seizure free at 2 months of follow up. (Engel Class 1). Surgical resection is feasible and potentially more effective in the early phase of clinical presentation of FCD.

scholarly journals Conservative management of eosinophilic enteritis presenting with acute abdominal syndrome

2013 ◽  
pp. 124-127
Author(s):  
Marco Bassi ◽  
Gelorma Belmonte ◽  
Carmelo Luigiano ◽  
Paola Billi ◽  
Angela Salerno ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Relevant Literature ◽  
Inflammatory Cells ◽  
Therapeutic Strategies ◽  
Acute Onset ◽  
Peripheral Eosinophilia ◽  
Diffuse Infiltration ◽  
Appropriate Therapy ◽  
Specific Symptoms

Eosinophilic enteritis, an increasing recognized condition, is rare and often presents with non-specific symptoms. We report a case of a 46-year old female who presented with acute onset abdominal pain and nausea associated with ascites, small bowel thickening and peripheral eosinophilia. Diagnosis was confirmed by biopsies taken at esophagogastroduodenoscopy demonstrating diffuse infiltration by inflammatory cells, mainly eosinophils. Appropriate therapy was instituted. The patient recovered well and was symptom-free at 1-month follow up. In this report, we discuss the clinical presentation and the diagnostic criteria of the eosinophilic enteritis, and examine the pathophysiological theories and therapeutic strategies. The relevant literature on eosinophilic enteritis is summarized.

Clinical presentation and surgical outcome of intramedullary spinal cord cavernous malformations

2012 ◽  
Vol 16 (3) ◽  
pp. 308-314 ◽  
Author(s):  
Xianzeng Tong ◽  
Xiaofeng Deng ◽  
Huan Li ◽  
Zhuang Fu ◽  
Yulun Xu
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Surgical Outcome ◽  
Clinical Presentation ◽  
Acute Onset ◽  
Intramedullary Spinal Cord ◽  
Cavernous Malformations ◽  
Recent Onset ◽  
Characteristic Imaging ◽  
Microsurgical Resection

Object Intramedullary spinal cord cavernous malformations (CMs), once thought to be extremely rare, have been diagnosed more frequently since the advent of MR imaging. In the literature, however, only a few studies include more than 10 cases. The aim of this study was to discuss the clinical presentation of intramedullary spinal cord CMs and the outcome of microsurgery for these histologically benign but clinically progressive lesions. Methods The authors retrospectively reviewed the records of 20 patients who underwent microsurgery for intramedullary spinal cord CMs. All patients had undergone pre- and postoperative MR imaging, and they were all treated using microsurgical resection. The diagnosis of spinal cord CMs was based on pathological criteria. The pre- and postoperative neurological states of the patients were classified according to the McCormick scale and Frankel scale. The microsurgical outcomes are presented and discussed. Results In most cases, CMs can be diagnosed on the basis of MR imaging findings, since these lesions have certain characteristic imaging patterns. Patients with intramedullary spinal cord CMs may present with either a rapid, acute onset of symptoms or slow, progressive neurological decline. The CMs in 19 of 20 patients in this series were totally resected, and most patients neurologically improved postoperatively. As previously reported, the authors confirm that the treatment of choice for symptomatic intramedullary CMs is total removal of the lesion to avoid recurrence and the possibility of further hemorrhage. Conclusions This study has defined the clinical features of symptomatic intramedullary spinal cord CMs. Surgery is the mainstay treatment. Surgical outcome is associated with low mortality with a high probability of functional recovery, especially when symptoms are not severe and are of relatively recent onset.

4094Microvascular dysfunction in takotsubo syndrome visualized at stress and rest using 82-rubidium PET imaging

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Kildevang Jensen ◽  
S Bentsen ◽  
L E Bang ◽  
L Holmvang ◽  
R Ripa ◽  
...  
Keyword(s):  
Acute Phase ◽  
Microvascular Dysfunction ◽  
Acute Onset ◽  
Cardiac Biomarkers ◽  
Takotsubo Syndrome ◽  
Flow Reserve ◽  
Induced Stress ◽  
Positron Emission ◽  
Coronary Obstruction

Abstract Introduction Takotsubo Syndrome (TTS) is recognized as the acute onset of reversible heart failure, often mimicking acute coronary syndrome with ECG changes and rise in cardiac biomarkers, but with no apparent coronary obstruction. The pathophysiological mechanisms of TTS are not yet fully understood, but it is well established that microvascular dysfunction and constriction plays a crucial role in the pathogenesis of TTS. Positron emission tomography (PET) using the radioactive tracer Rubidium-82 (Rb-82) is routinely used to asses myocardial perfusion and microvascular function in a wide array of cardiological conditions. Purpose The purpose of this study was to evaluate myocardial perfusion and flow reserve in patients with TTS using Rb-82 positron emission tomography (PET) molecular imaging during rest and pharmacologically induced stress, in the acute phase and after 3 months of follow-up. Methods A total of 8 patients were diagnosed with TTS due to acute onset of symptoms, rise in cardiac biomarkers, absence of significant coronary obstruction and apical ballooning of the left ventricle. Subsequently the patients underwent Rb-82 PET scan in the acute phase (1–4 days after onset), and again at 3 months of follow-up. Rb-82 PET scans were performed both during resting conditions and during pharmacologically induced stress with infusion of adenosine. Myocardial blood flow (MBF) and total perfusion defect (TPD) were quantified during rest and stress, and the coronary flow reserve (CFR) was calculated. The AHA-17 segment model was used to determine summed rest scores (SRS) and summed stress scores (SSS). Data are presented as means ± SEM Results MBF during stress was significantly lower in the acute phase than at 3 months follow-up (2.99±0.35 vs. 3.82±0.19 ml/g/min, P=0.016) as opposed to resting MBF, which did not differ significantly (1.33±0.14 vs. 1.45±0.09 ml/g/min, P=0.309). The CFR of the patients was not significantly different in the acute phase compared to 3 months follow-up (2.33±0.25 vs 2.65±0.12, P=0.11), though 4 of the patients had a CFR <2.0 in the acute phase, which was normalized at follow-up. TPD was significantly lower at follow-up compared to the acute phase at both rest (21.6±5.86 vs. 0.75±0.61%, P=0.009) and stress (25.3±6.01 vs. 1.25±0.31%, P=0.006). SRS (12.6±3.24 vs. 0.75±0.59, P=0.01) and SSS (19.9±3.39 vs. 1.38±0.59, P=0.001) was significantly higher in the acute phase compared to follow-up. At follow up, all values were normalized. Figure 1 Conclusion These results supports the evidence that TTS is partly caused by microvascular dysfunction and constriction during the acute phase. Further studies are needed to uncover the exact mechanisms behind.

The FUSION iENA Study: Comparison of I-124-PET/US Fusion Imaging with Conventional Diagnostics for the Functional Assessment of Thyroid Nodules by Multiple Observers

2019 ◽  
Vol 58 (06) ◽  
pp. 434-442 ◽  
Author(s):  
Thomas Winkens ◽  
Philipp Seifert ◽  
Christian Hollenbach ◽  
Christian Kühnel ◽  
Falk Gühne ◽  
...  
Keyword(s):  
Functional Assessment ◽  
Thyroid Nodules ◽  
Radioiodine Therapy ◽  
Fusion Imaging ◽  
Needle Aspiration ◽  
Patient Case ◽  
Positron Emission ◽  
Thyroid Medication ◽  
Case Files

Abstract Aim To investigate the value of I-124 positron emission tomography (PET) / ultrasound (US) fusion imaging in comparison to conventional diagnostics (CD) of Thyroid nodules (TN) by multiple observers. Methods Digital patient case files (PCF) of patients that received CD and I-124-PET/US in clinical routine were prepared containing cine-loops of the examinations. All physicians with nuclear medicine specialty from Germany, Austria, and Switzerland were invited to participate. 106 acquired observers completed 7.2 ± 1.8 (median: 8, range: 4–14) randomly assigned PCF (CD only or CD+PET/US). They assessed the TN function, stated their confidence in functional assessment, and suggested a treatment course for each TN. Results 68 PCF of 34 patients comprising 66 TN ≥ 1 cm (= 1.94 TN/patient) were created. A total of 748 (11.2/TN), and 751 ratings (11.4/TN) were recorded for CD only, and CD+PET/US, respectively. The functional assessment revealed more hyper- or hypofunctioning (524 vs. 320, p < 0.0001) and less indifferent or not rateable (209 vs. 428, p < 0.0001) TN in CD+PET/US vs. CD only. The observers’ confidence in functional assessment was superior in CD+PET/US (p < 0.0001). Furthermore, the ratings were carried out more homogeneous in CD+PET/US (p < 0.0001). Fewer suggestion of follow up (p < 0.0001), and more (p < 0.0001) suggestion of invasive treatments (fine-needle aspiration & surgery) was observed in CD+PET/US. Radioiodine therapy was more often (p = 0.0036), and thyroid medication less often (p = 0.0167) advised in CD+PET/US. Conclusion Functional assessment of equivocal TN shows frequent failures in CD, underestimating the incidence of hyper- and hypofunctioning lesions. Confidence in functional assessment significantly increases with additional PET/US. This influences the proposed treatment course.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

Necrosis avascular

2020 ◽  
Vol 63 (2) ◽  
pp. 18-23
Author(s):  
Alejandro Jardón Gómez ◽  
Ana Cristina King ◽  
Carlos Pacheco Díaz
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Femoral Fracture ◽  
Open Fracture ◽  
Clinical Presentation ◽  
Femoral Fractures ◽  
Proximal Femoral Fracture ◽  
Young Population ◽  
Steroid Use

The clinical presentation of a proximal femoral fracture is completely different between young and adult patients. Unlike closed proximal femoral fractures, the incidence of exposed fractures is found in the young population between 15 and 30 years of age. Osteonecrosis of the femoral head is one the complications we can find in this type of fractures. Avascular necrosis (AVN or osteonecrosis) is defined as the interruption of blood supply to the femoral head due to trauma, infectionalcohol or steroid use, resulting in bone necrosis, joint collapse and osteoarthrosis. The treatment will depend on the clinical presentation, age of the patient and when the diagnosis is made. This is a case report of a 16-year-old patient with a gunshot wound on the hip. Surgical cleansing and closed reduction plus internal fixation with a nail in the center of the spine were performed. A 3-year clinical and radiographic follow up was made, observing the evolution of the fracture and the subsequent avascular necrosis that the patient presented. Key words: Proximal femoral fracture; hip; avascular necrosis (AVN, osteonecrosis); open fracture; osteoarthritis.

scholarly journals When less is more: a daring conservative approach to postpneumonectomy oesophago-pleural fistula

2019 ◽  
Vol 30 (1) ◽  
pp. 146-148
Author(s):  
Lara Girelli ◽  
Elena Prisciandaro ◽  
Niccolò Filippi ◽  
Lorenzo Spaggiari
Keyword(s):  
Clinical Presentation ◽  
Clinical Status ◽  
High Morbidity ◽  
Conservative Approach ◽  
Chronic Fistula ◽  
Less Is More ◽  
Primary Surgery ◽  
History Of ◽  
Uncommon Complication

Abstract Oesophago-pleural fistula is an uncommon complication after pneumonectomy, usually related to high morbidity and mortality. Due to its rarity and heterogeneous clinical presentation, its diagnosis and management are challenging issues. Here, we report the case of a patient with a history of pneumonectomy for a tracheal tumour, who developed an asymptomatic oesophago-pleural fistula 7 years after primary surgery. In consideration of the patient’s good clinical status and after verifying the preservation of respiratory and digestive functions, a bold conservative approach was adopted. Five-year follow-up computed tomography did not disclose any sign of recurrence of disease and showed a stable, chronic fistula.

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