Subacute posttraumatic ascending myelopathy: A case report and review of literature

Subacute posttraumatic ascending myelopathy is a rare disorder, unrelated to syrinx formation or mechanical instability, which may gradually emerge within the first 1-2 weeks after a spinal cord injury and may lead to diagnostic and prognostic dilemmas. We present a case of 24-year-old female with unstable wedge compression fracture of L₁ vertebrae with signal changes in the upper lumbar cord causing complete paraplegia below D₉ with bladder and bowel involvement. In the subsequent week, she developed a delayed progressively increasing neurological deficit with cord signal abnormality on MRI extending cephalad from the injury site to the upper dorsal cord. The patient had no initial clinical improvement initially but showed a delayed recovery over months.     

肝癌动脉导管化疗栓塞术后并发脑碘油栓塞1例的护理及文献复习

对1例肝癌动脉导管化疗栓塞术后并发脑碘油栓塞患者行吸氧、脱水、保护脑细胞和改善微循环治疗。结果患者脑栓塞治愈。结合国内外15篇个案报道,回顾分析患者诊疗护理过程,探讨其发病机制、危险因素。提出肝癌动脉导管化疗栓塞术并发脑碘油栓塞极少见,熟悉其危险因素,可早期预防干预,术后及时发现、积极对症处理,预后多良好。     

A one case report of cerebral lipiodol embolism following transcatheter arterial chemoembolization for hepatocellular carcinoma and the literature review

对1例肝癌动脉导管化疗栓塞术后并发脑碘油栓塞患者行吸氧、脱水、保护脑细胞和改善微循环治疗.结果患者脑栓塞治愈.结合国内外15篇个案报道,回顾分析患者诊疗护理过程,探讨其发病机制、危险因素.提出肝癌动脉导管化疗栓塞术并发脑碘油栓塞极少见,熟悉其危险因素,可早期预防干预,术后及时发现、积极对症处理,预后多良好.     

Intrathoracic meningocele. A case report and review of the literature]

In this article the Authors describe a case of intrathoracic meningocele. That was diagnosed in a young asymptomatic woman after surgical resection. After a complete and accurate review of the literature, the Authors underline the rarity of the find while they also note the association of this pathology with Von Recklinghausen's neurofibromatosis. They also discuss etiology and clinical diagnostic aspects as well. In conclusion the Authors insist that with new diagnostic imaging techniques available today it is possible to accurately diagnose this disease preoperatively in most patients. This fact along with improved therapeutic regimens makes surgical excision almost free from the complications that were at one time observed.     

Adrenal myelolipoma. A case report and review of the literature]

Myelolipoma is a rare benign neoplasm of the adrenal gland, histologically characterized by the presence of mature fat cells and bone marrow elements. In the international literature were reported 126 cases of adrenal myelolipoma surgically treated. The indications to surgical removal of this tumor are the presence of large symptomatic tumours, high risk of spontaneous haemorrhage, and suspicion of malignant neoplasms. The authors present a case of adrenal myelolipoma, preoperatively identified with an abdominal MNR, and surgically removed.     

Hemifacial spasm caused by pontine glioma: case report and review of the literature

Hemifacial spasm (HFS) is an involuntary paroxysmal contractions of the facial musculature, caused generally by vascular compression of the seventh cranial nerve at its root exit zone from the brain stem. The case of an adult man harbouring brain stem glioma (BSG) whose only neurological signs were left HFS and mild facial weakness is reported. Radiological and neurophysiological findings are described. No responsible vessel could be identified during surgery, but the causative lesion was found to be an astrocytic tumour encasing the facial nerve at its root exit zone from the brain stem. The rarity of such a condition prompted us to review the literature. Nine cases, including our patient presenting with HFS caused by BSG, are reviewed.     

Primitive cerebral melanoma: case report and review of the literature

BACKGROUND: Central nervous system primary malignant melanoma accounts for approximately 1% of all the cases of melanoma; reports in the literature are relatively rare. CASE DESCRIPTION: A 74-year-old man was hospitalized because of an episode of aphasia. The neuroradiologic examinations demonstrated a round homogeneous lesion extending near the left sylvian fissure. He had no extracranial abnormalities. The patient underwent a neurosurgical procedure and the tumor was macroscopically totally excised. Pathological examination of the surgical specimen revealed a histological appearance similar to that of melanoma. A diagnosis of primary CNS melanoma was made after careful dermatologic and ophthalmologic examination, which ruled out presence of cutaneous or choroidal melanoma. The patient did not receive any further treatment and he is free of disease 2 years after diagnosis. CONCLUSIONS: We report a case of primary cerebral melanoma of the left temporal lobe; clinical, neuroradiological, and histological findings are discussed with review of the literature. Primary melanoma of the CNS may present either with localized intra/extra-axial mass lesions or with meningeal spread, which carries a worse prognosis. The prognosis of cerebral primitive melanoma is variable, although it is common opinion that primitive cerebral melanoma has a better prognosis than cutaneous melanoma, with two cases in the literature surviving 9 and 12 years.     

Clival chordoma in an infant; case report and review of the literature]

Skull base chordoma in infants is a very rare entity in spite of its congenital origin; only 11 clinical cases can be found in the literature so far. Here we report such a case and review the literature. The case is that of a 3.5-year old boy suffering from left abducent nerve palsy for 5 months. CT scan revealed an isodense mass lesion with bone destruction involving the clivus and left petrous apex, and was homogeneously enhanced on post-contrast study. MRI disclosed the clival tumor as a long T1 and long T2 mass. Angiogram showed no tumor stain. The tumor was preoperatively diagnosed as clival chordoma, and was partially removed via left transpetrosal-transtentorial approach. The tumor was found to extend into the subdural space through Dorrello's canal and compress the abducent nerve. Histological examination with H & E, PAS, mucicarmine, and reticulin stainings led us to a diagnosis of "typical chordoma". Electron microscopy demonstrated the mitochondria-endoplasmic reticulum complexes (MERC), glycogen granules, and vacuoles in the tumor cells. Postoperative irradiation (total dose 55 Gy) was performed. At present, 30 months after the operation, no evidence of tumor regrowth nor hypothalamus-pituitary deficiency is recognizable and the patient is free from left abducent nerve palsy. It is concluded that skull base chordoma in infants should be postoperatively irradiated in an appropriate manner.     

Multiple sequential posttraumatic pseudoaneurysms following high-energy injuries: case report and review of the literature

A 15-year-old boy sustained severe multisystem injuries from a satchel charge while in his native village in southern Lebanon. After evacuation and resuscitation measures, he had successful intensive multidisciplinary surgical care. His long-bone fractures were stabilized by tubular external fixation systems, and his lacerated right tibialis anterior artery was grafted. Twenty days after injury, he developed a pseudoaneurysm of the left distal ulnar artery, which was surgically resected and the ulnar artery proximally ligated. Two weeks later, a pseudoaneurysm of the left peroneal artery, distal to the knee and coupled with an arteriovenous fistula, was diagnosed. This was treated by fluoroscopic controlled embolization with placement of stents. The patient recovered uneventfully. He was last seen two years after surgery, and no gross vascular compromise of any of his limbs was evident. This appears to be the only reported patient with late-developing multiple posttraumatic pseudoaneurysms after severe blast and shrapnel injuries. This development suggests that late sequelae of blast injuries may be topographically widespread and can evolve months after the injury. As such, these patients should be followed closely with a high degree of suspicion for the appearance of new signs or symptoms.     

Pulmonary arterial hypertension due to ventriculoatrial shunts: A case report and literature review

Cardiopulmonary complications are infrequent in patients with ventriculoatrial shunts (VAS). We report the case of an 18-year-old man with congenital hydrocephalus who developed pulmonary arterial hypertension (PAH) in the long-term follow-up after a VAS procedure. He presented with progressive exertional dyspnea, stabbing chest pain and acral cyanosis. Echocardiography showed severe PAH and a digitiform mass adhered to the distal catheter. A ventilation/perfusion scan suggested chronic pulmonary embolisms. Anticoagulation with intravenous heparin was started and thrombus resolution was achieved, but PAH remained. It is necessary to bear in mind complications linked to VAS when treating a patient with this device.     

Traumatic subclavian arterial rupture: a case report and review of literature

ABSTRACT: Subclavian artery injuries represent an uncommon complication of blunt chest trauma, this structure being protected by subclavius muscle, the clavicle, the first rib, and the deep cervical fascia as well as the costo-coracoid ligament, a clavi-coraco-axillary fascia portion. Subclavian artery injury appears early after trauma, and arterial rupture may cause life-treatening haemorrages, pseudo-aneurysm formation and compression of brachial plexus. These clinical eveniences must be carefully worked out by accurate physical examination of the upper limb: skin color, temperature, sensation as well as radial pulse and hand motility represent the key points of physical examination in this setting. The presence of large hematomas and pulsatile palpable mass in supraclavicular region should raise the suspicion of serious vascular injury. Since the first reports of endovascular treatment for traumatic vascular injuries in the 90's, an increasing number of vascular lesions have been treated this way. We report a case of traumatic subclavian arterial rupture after blunt chest trauma due to a 4 meters fall, treated by endovascular stent grafting, providing a complete review of the past twenty years' literature.     

Arthroscopic release of a posttraumatic flexion contracture in the elbow: A case report and review of the literature

Open arthrotomy has been the standard of treatment for posttraumatic flexion contractures of the elbow. Utilizing standard arthroscopic techniques combined with electrocautery, anterior capsulotomy was performed without complication. Immediate improvement in extension was demonstrated. Multiple cadaveric dissections evidenced the safety of the approach as the humeral capsular attachment is isolated from the neurovascular structures by the brachialis muscle. This technique serves to underscore the utility of elbow arthroscopy in patients with dysfunction previously only amenable to open joint procedures.     

Verrucous carcinoma of the penis. A case report and review of the literature]

The Authors report a case of a verrucous carcinoma of the penis. Among male malignant epithelial tumors the verrucous carcinoma represents a very rare form, with a typical oesophitic development, of vegetating sometimes ulcerated appearance, with slow evolution that rarely presents metastases. Although a therapeutic preservation approach is possible, a surgical operation is the treatment of choice.     

Gastroduodenal arterial aneurysms: report of a case and review of the literature.

Aneurysms of the gastroduodenal artery are rare. Only nine cases have been reported previously. These aneurysms are extremely difficult to diagnose preoperatively. A case of ruptured gastroduodenal artery aneurysm, which was diagnosed by aortography prior to operation, is reported, and the literature is reviewed.     

Traumatic middle cerebral artery aneurysm: case report and review of the literature

Traumatic intracranial aneurysms are rare. A case of traumatic middle cerebral artery aneurysm was presented. A 66-year-old man sustained a severe head injury in a bicycle accident. Serial computed tomography and angiography showed the delayed intracerebral hemorrhage caused by the traumatic middle cerebral artery aneurysm. The aneurysm was trapped and removed. Histological examination clearly revealed the pseudoaneurysm. Traumatic middle cerebral aneurysms were reviewed.