Acute Nontraumatic Spinal Intradural Hematoma in a Patient on Warfarin

Background

Nontraumatic spinal intradural extramedullary hematomas are extremely rare. When they occur, they can rapidly lead to spinal cord or cauda equina compression and have devastating consequences.

Objective

The aim here was to report a case of this rare phenomenon and discuss the etiology, imaging, management, and outcome of intradural hematomas.

Case Report

We describe the case of a 76-year-old man on warfarin therapy who presented with severe lower back pain and flaccid paraparesis. Blood tests revealed an international normalized ratio of 6.0. A magnetic resonance imaging result suggested an intradural hematoma extending from L1 to L4 and compressing the spinal cord and cauda equina. Emergency surgical decompression revealed an extensive intradural extramedullary hematoma, which was evacuated. The patient showed only minor neurologic improvement 6 months postoperatively.

Conclusions

Coagulopathy-induced spinal hemorrhage should be included in the differential diagnosis for patients presenting with signs of acute spinal cord compression.     

Temporomandibular joint osteochondromatosis: an unusual cause of preauricular swelling

We report an unusual and rare cause of preauricular swelling and review the most recent literature concerning synovial osteochondromatosis of the temporomandibular joint. We report the clinical and radiologic findings of a case of synovial osteochondromatosis of the temporomandibular joint that presented as preauricular swelling in a female patient. This disease typically affects large joints; fewer than 100 cases reported in the literature affect the temporomandibular joint. This case illustrates that disorders of the temporomandibular joint should also be included in the differential diagnosis of patients who present with a preauricular mass.     

CDH1 pathogenic variants and cancer risk in an unselected patient population

Familial Cancer - CDH1 pathogenic variants confer a markedly elevated lifetime risk of developing diffuse gastric cancer (DGC) and lobular breast cancer (LBC). The aim of this study was to evaluate...     

Optical Coherence Tomography for the Early Detection of Coronary Vascular Changes in Children and Adolescents After Cardiac Transplantation: Findings From the International Pediatric OCT Registry

ObjectivesThis study sought to describe the initial findings from the International Pediatric Optical Coherence Tomography (OCT) registry in pediatric heart transplant recipients.BackgroundCardiac allograft vasculopathy (CAV) is a common cause of late graft failure and mortality in pediatric heart transplant recipients. Early diagnosis may improve outcomes. OCT is a high-resolution intravascular imaging technique that has the potential to identify CAV earlier than angiography.MethodsOCT and angiography of the coronary arteries were performed in pediatric heart transplant recipients at participating centers. Demographics, clinical data, medications, episodes of rejection, and angiographically confirmed CAV were collected for each case. OCT and angiography images were analyzed in a central core imaging laboratory. Intimal thickness and intima/media cross sectional area (I/M CSA) ratios were calculated for each case. Intimal thickness ≥0.25 mm was defined as abnormal and ≥0.4 mm as severe intima thickening. I/M CSA ratio of ≥1 was defined as abnormal. OCT findings were compared to angiographic findings for each case.ResultsAcross 3 centers, 110 cases were analyzed from 76 patients. Intimal thickening was present in 26 of 110 cases. Eleven of these cases had severe intima thickening (≥0.4 mm) and notably, angiography results were normal in 8 cases. All 5 cases with a median I/M CSA ratio of ≥2 had normal angiography. The maximal intima thickness was ≥0.25 mm in 24% and ≥0.4 mm in 10% of cases. Median I/M CSA ratio was ≥1 for 80% of cases. I/M CSA ratio was significantly higher in cases with concurrent CAV (p = 0.03). Maximal intima thickness was significantly greater in cases with current or previous rejection (p = 0.01). I/M CSA ratio was significantly lower in patients treated with statins (p = 0.01). OCT findings alone prompted a change to medical management in 17% of cases.ConclusionsOCT provides important insights into coronary vascular changes not detected by angiography in pediatric transplant recipients. The use of OCT for pediatric heart transplant recipients should be further investigated, given its potential to impact the management of CAV.     

Women and firesetting: A qualitative analysis of context, meaning, and development

Objectives. To explore subjective experiences of women in secure services of their firesetting behaviour, its personal meaning and the factors that contributed to its development. Design. An interview-based study using Interpretative Phenomenological Analysis. Methods. Interviews were carried out with nine women, in medium secure services, with histories of firesetting. Results. Three overarching but interlinked themes emerged, reflecting a narrative progression from the context of life experiences that preceded firesetting (including subthemes: distressing experiences and isolation from support), through the experience and meaning of the firesetting act (influencing others and getting help, achievement and control, and not thought through), to the individual's current position regarding past actions. Conclusions. The clinical implications of the findings are considered in the context of the existing male-orientated firesetting knowledge base and emerging models of service delivery to women in secure settings.