Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anor...Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anorexia, spinal abnormalities, diabetes mellitus and electrolyte imbalance. Without proper and timely diagnosis and treatment, gastric perforation and hemorrhage can occur. In this report, we present a case of acute massive gastric dilation in a settling of type II diabetes mellitus and urosepsis. We will also present a review of literature and management options for such condition. Our report highlights the need for high index of suspicion and early intervention to avoid life threatening complications.展开更多
Intracranial hypotension (ICH) is a benign syndrome which is often under-diagnosed. It is characterized by orthostatic headache which is predominantly occipital. ICH is diagnosed in the presence of a typical history a...Intracranial hypotension (ICH) is a benign syndrome which is often under-diagnosed. It is characterized by orthostatic headache which is predominantly occipital. ICH is diagnosed in the presence of a typical history and characteristic imaging findings. Further confirmation by lumbar puncture to document low CSF pressure might be necessary in some cases. Treatment is mainly conservative in the form of bed rest and intravenous saline infusion. However, surgical intervention may be required if conservative measures fail. In this report we presented a case of 42-year-old male patient who presented with symptoms of orthostatic occipital headache of three-month duration and was subsequently diagnosed with intracranial hypotension based on characteristic MRI findings of pachymeningeal enhancement on gadolinium enhanced MRI of the brain with sagging of the mid-brain.展开更多
Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional...Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional state, encephalopathy, meningism, convulsions and focal neurological deficits. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare and limited to only a few case reports [2]. Here we report a case of enteric fever who presents Acute Cerebellar Ataxia.展开更多
Introduction: Despite recent advances in neuroimaging and microsurgical techniques, surgical resection of spinal cord tumours remains a challenge. However, the evolution with advances and refinement of neurophysiologi...Introduction: Despite recent advances in neuroimaging and microsurgical techniques, surgical resection of spinal cord tumours remains a challenge. However, the evolution with advances and refinement of neurophysiological equipment and methodologies, intra-operative neurophysiolo- gical monitoring (IONM) is now regarded as an essential adjunct to the surgical management of intramedullary spinal cord tumours. This study aims to report our preliminary experience with IONM and emphasise its effective role of achieving maximum tumour resection and minimising neurological injury. Methods: This is a retrospective study performed at our institution between July 2012 and August 2013. It included a cohort of 6 consecutive patients presented with intramedullary spinal cord tumours. Their mean age was 26 years (range, 4 months - 37 years), all were males, and the mean follow up was 11.6 months. Results: We combined the use of somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in spinal cord surgery. SSEPs are monitored during the incision of the dorsal midline of the spinal cord and this was used in two of our patients and MEPs were used as an essential monitoring during the tumour resection. In addition, we used free-running electromyography (EMG) and muscle MEPs (mMEPs) during tumour resection. Four of our patients (two with ependymoma, one with ganglioglioma, and one with pilocytic astrocytoma) had complete tumour resection and two patients (pilocytic and diffuse astrocytoma) had IONM changes during surgery and had partial tumour resection. At 6-month follow up all our patients had made a good recovery with no new neurological sequelae. Conclusion: This small series and literature review is presented to add and improve the understanding of IONM in intramedullary spinal cord procedures and to reinforce the importance of IONM in optimising tumour resection and neurological outcome. Our series confirm that without D-wave monitoring, free-running EMG and MEP monitoring during tumour resection remain an important adjunct. We also draw attention to the fact that changes in the free-running EMG occur before any changes in the MEPs are noted.展开更多
An empty sella occurs due to herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the ...An empty sella occurs due to herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the sella. Empty sella syndrome is considered as a less common entity and is usually asymptomatic and an incidental finding. However, it can be a manifestation of increased intracranial pressure and can be occasionally severe. Compression of the pituitary gland may affect function, or traction on the optic chiasm and nerves may cause visual symptoms. An empty sella may be classified as primary when this occurs in persons who have not received pituitary radiation or pituitary surgery, while an empty sella discovered following such procedures is classified as secondary empty sella. In this report, we presented a 41-year-old multiparous patient who presented to us with symptoms of headache and left sided hemi-sensory disturbance. Examination was unrevealing except for the fact that she was obese. On evaluation, she was detected to have impaired blood sugars, dyslipidemia and vitamin insufficiency. MRI brain revealed presence of Empty Sella. Further hormonal analysis was normal. She was treated conservatively and regular follow-up was advised.展开更多
文摘Acute gastric dilation leading to ischemia of the stomach is an underdiagnosed condition and can be potentially fatal. It can occur in various medical and surgical conditions such as post operative state, trauma, anorexia, spinal abnormalities, diabetes mellitus and electrolyte imbalance. Without proper and timely diagnosis and treatment, gastric perforation and hemorrhage can occur. In this report, we present a case of acute massive gastric dilation in a settling of type II diabetes mellitus and urosepsis. We will also present a review of literature and management options for such condition. Our report highlights the need for high index of suspicion and early intervention to avoid life threatening complications.
文摘Intracranial hypotension (ICH) is a benign syndrome which is often under-diagnosed. It is characterized by orthostatic headache which is predominantly occipital. ICH is diagnosed in the presence of a typical history and characteristic imaging findings. Further confirmation by lumbar puncture to document low CSF pressure might be necessary in some cases. Treatment is mainly conservative in the form of bed rest and intravenous saline infusion. However, surgical intervention may be required if conservative measures fail. In this report we presented a case of 42-year-old male patient who presented with symptoms of orthostatic occipital headache of three-month duration and was subsequently diagnosed with intracranial hypotension based on characteristic MRI findings of pachymeningeal enhancement on gadolinium enhanced MRI of the brain with sagging of the mid-brain.
文摘Enteric fever is widely prevalent in the tropics. Central nervous system involvement is not rare and reported incidence varies from 5% to 35% [1]. Various well-known neuropsychiatric manifestations include confusional state, encephalopathy, meningism, convulsions and focal neurological deficits. Acute cerebellar ataxia as an isolated neurological complication of enteric fever is very rare and limited to only a few case reports [2]. Here we report a case of enteric fever who presents Acute Cerebellar Ataxia.
文摘Introduction: Despite recent advances in neuroimaging and microsurgical techniques, surgical resection of spinal cord tumours remains a challenge. However, the evolution with advances and refinement of neurophysiological equipment and methodologies, intra-operative neurophysiolo- gical monitoring (IONM) is now regarded as an essential adjunct to the surgical management of intramedullary spinal cord tumours. This study aims to report our preliminary experience with IONM and emphasise its effective role of achieving maximum tumour resection and minimising neurological injury. Methods: This is a retrospective study performed at our institution between July 2012 and August 2013. It included a cohort of 6 consecutive patients presented with intramedullary spinal cord tumours. Their mean age was 26 years (range, 4 months - 37 years), all were males, and the mean follow up was 11.6 months. Results: We combined the use of somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs) in spinal cord surgery. SSEPs are monitored during the incision of the dorsal midline of the spinal cord and this was used in two of our patients and MEPs were used as an essential monitoring during the tumour resection. In addition, we used free-running electromyography (EMG) and muscle MEPs (mMEPs) during tumour resection. Four of our patients (two with ependymoma, one with ganglioglioma, and one with pilocytic astrocytoma) had complete tumour resection and two patients (pilocytic and diffuse astrocytoma) had IONM changes during surgery and had partial tumour resection. At 6-month follow up all our patients had made a good recovery with no new neurological sequelae. Conclusion: This small series and literature review is presented to add and improve the understanding of IONM in intramedullary spinal cord procedures and to reinforce the importance of IONM in optimising tumour resection and neurological outcome. Our series confirm that without D-wave monitoring, free-running EMG and MEP monitoring during tumour resection remain an important adjunct. We also draw attention to the fact that changes in the free-running EMG occur before any changes in the MEPs are noted.
文摘An empty sella occurs due to herniation of the arachnoid through an incompetent diaphragma sellae. Over time, cerebrospinal fluid (CSF) pulsations may enlarge the sella and compress the gland against the floor of the sella. Empty sella syndrome is considered as a less common entity and is usually asymptomatic and an incidental finding. However, it can be a manifestation of increased intracranial pressure and can be occasionally severe. Compression of the pituitary gland may affect function, or traction on the optic chiasm and nerves may cause visual symptoms. An empty sella may be classified as primary when this occurs in persons who have not received pituitary radiation or pituitary surgery, while an empty sella discovered following such procedures is classified as secondary empty sella. In this report, we presented a 41-year-old multiparous patient who presented to us with symptoms of headache and left sided hemi-sensory disturbance. Examination was unrevealing except for the fact that she was obese. On evaluation, she was detected to have impaired blood sugars, dyslipidemia and vitamin insufficiency. MRI brain revealed presence of Empty Sella. Further hormonal analysis was normal. She was treated conservatively and regular follow-up was advised.
