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A Rare Presentation of a Case of Cerebral Mucormycosis as a Solitary Intraparenchymal Lesion
Anna Balaji Karthikeyan,
Rakesh Gupta,
Zafar Sheikh
Issue:
Volume 6, Issue 1, June 2022
Pages:
1-6
Received:
6 January 2022
Accepted:
28 January 2022
Published:
9 February 2022
Abstract: Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral mucormycosis, in the absence of rhino-orbital focus, is an extremely rare but life-threatening infection of central nervous system that is most commonly found in intravenous drug abuser. We present a case of isolated cerebral mucormycosis that presented as a case of malignant glioma and was later diagnosed as a case of cerebral mucormycosis by open biopsy and treated with antifungals. A 45-year-old male patient presented to the casualty with complaints of altered behaviour and speech with right hemiparesis for 1 week. He also lost continence of micturition and defecation. Though the patient was conscious, his presenting GCS was E4V1M6. He had suffered from COVID-19 infection 2 months back and recovered without any steroid medications. An MRI (tumour protocol) of the brain and a CECT brain revealed a high grade multicentric glial neoplasm involving left thalamocapsular region and extending into adjacent cortical/subcortical left high parietal and posterior temporal lobe and a midline shift of 6-8mm to the right. A left parietal craniotomy was done which revealed a pus-filled cavity which was drained, and marsupialization of cavity wall was done. Biopsy revealed the final diagnosis of Isolated cerebral Mucormycosis. Isolated Cerebral mucormycosis is a rare occurence and a confusing presentation and thus, an intracranial SOL should be approached with caution to minimize patient morbidity.
Abstract: Rhinocerebral mucormycosis is an opportunistic infection of the sinuses, nasal passages, oral cavity, and brain caused by saprophytic fungi and is known to be rare in occurence. This infection can result in a rapid death. Rhinocerebral mucormycosis is known to commonly affect individuals who are in an immunocompromised state. Isolated cerebral muco...
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Evaluation of the Use of Drain in Anterior Cervical Disc Fusion Procedures
Rodrigues Junior Jose Carlos,
Da Silva Vithor Ely Bortolin,
De Campos Marcelo Ferraz
Issue:
Volume 6, Issue 1, June 2022
Pages:
7-10
Received:
20 January 2022
Accepted:
1 March 2022
Published:
9 March 2022
Abstract: Introduction: The worldwide tendency is to minimize surgical treatments, providing lesser incisions, length of hospitalization and complications. Anterior cervical arthrodesis (ACA) is a very common procedure realized daily in many services. One of its most dread complications it’s the cervical hematoma that in severe cases need urgent evacuation and can lead to higher morbidity and even death. Despite of this is not a consensus between surgeons to use or not a drain in ACA. We retrospectively analyzed the use of a drain in patients submitted to ACA and evaluate the results of minimizing cervical collections caused by the lowest symptomatology in the post-operative period. Materials and Methods: Fifty-four patients submitted to ACA in one or more segments were retrospectively evaluated, through the analysis of medical records, examinations, surgical descriptions, as well the output of each drain in the postoperative period, conditions of the surgical wound (presence or not of bulging) and postoperative symptomatology (swallowing and local pain). The data obtained were submitted to statistical analysis. Results: 54 patients underwent ACA. The overall mean volume of cervical drain was 28.56 mL (10 - 90 ml). A direct relationship was observed between the number of levels operated and the mean drain output: 1 level=12.86 ml; 2 levels=27.88 ml; and 3 levels=32.60 ml with statistical significance (p<0.0001). In all patients, minimal or no cervical bulging, nor dysphagia was observed. Conclusion: We conclude that the use of the drain in ACA reduces the cervical collections, regardless of the number of segments addressed, causing less postoperative symptomatology with consequent decrease in hospitalization time, and because independent of levels we observed significant accumulation of blood we recommend that every surgeon dealing with ACA must use routinely a drain.
Abstract: Introduction: The worldwide tendency is to minimize surgical treatments, providing lesser incisions, length of hospitalization and complications. Anterior cervical arthrodesis (ACA) is a very common procedure realized daily in many services. One of its most dread complications it’s the cervical hematoma that in severe cases need urgent evacuation a...
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Carotid Artery Disease: Multivariate Analysis of a Single Center in Mexico City
Daniel Alejandro Vega-Moreno,
José Ramón Aguilar-Calderón,
María Elena Córdoba-Mosqueda,
Víctor Andrés Reyes-Rodríguez,
Mauricio Daniel Sánchez-Calderón,
José Omar Santellán-Hernández,
Diego Ochoa-Cacique,
Carlos Betancourt-Quiroz,
Mario Alberto Dueñas-Espinoza,
Andrés Alberto Moral-Naranjo,
Martha Elena González-Jiménez,
Ulises García-González
Issue:
Volume 6, Issue 1, June 2022
Pages:
11-18
Received:
2 March 2022
Accepted:
14 April 2022
Published:
10 May 2022
Abstract: Introduction. Stroke is the fourth leading cause of death in the United States and the leading cause of disability. Of these, carotid artery disease is responsible for up to 15% to 30% of strokes. The objetive is knowing the risk factors and their impact on four possible scenarios in the diagnosis and treatment of carotid artery disease. 1: significant stenosis measured by ultrasound Doppler carotid, 2: significant stenosis measured by diagnostic cerebral angiography, 3: plaque ulceration measured by angiography, and 4: carotid stent placement. Material and Methods. A retrospective study was carried out with 29 patients, 12 patients to whom was placed a carotid stent and 17 control patients, Odds ratio was calculated for risk factors: high blood pressure, diabetes, cancer, smoking and dyslipidemia. And then multivariate analysis was performed with the same variables. Results. For the risk factors with statistical significance for carotid ulcer were dyslipidemia and cancer, and for stent placement, smoking, and clinically presented as a transient ischemic attack. For the multivariate analysis, the only factor associated with stent placement was smoking. Conclusions. Of the entire range of risk factors associated with cerebrovascular disease, tobacco use is the factor most strongly associated with a patient with carotid disease ending up in endovascular treatment. So prevention or lifestyle modification is the best tool to avoid these outcomes.
Abstract: Introduction. Stroke is the fourth leading cause of death in the United States and the leading cause of disability. Of these, carotid artery disease is responsible for up to 15% to 30% of strokes. The objetive is knowing the risk factors and their impact on four possible scenarios in the diagnosis and treatment of carotid artery disease. 1: signifi...
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Computed Tomographic Measurement of Thoracic Pedicle in Filipino Patients
Billy Francis Yu Hung,
Paolo Antonio Florencio Castro
Issue:
Volume 6, Issue 1, June 2022
Pages:
19-22
Received:
24 April 2022
Accepted:
7 May 2022
Published:
12 May 2022
Abstract: Knowledge of the morphometric measurements of Filipino thoracic spine pedicles would help the surgeons in determining the proper size and increase accuracy of pedicle screws placement during surgery to avoid complications. This study aims to measure the outer diameter, chord length and transverse angulation of the thoracic spine pedicles (T1-T12). A retrospective analysis of patients ages 18-85 years who underwent CT scan of the thoracic spine from January to December 2019. A total of 65 patients were included in the study. Pedicle morphology was measured with the following: transverse outer pedicle diameter, pedicle chord length, and transverse pedicle angle. TOPD was narrowest at the level of T4 (4.2 ± 1.0mm) followed by T5 (4.6 ± 1.0mm) and the largest TOPD at the level of T12 (8.7 ± 2.1mm). The largest PCL was at the level T12 (47.7 ± 4.6mm) and the shortest was at T2 (35.6 ± 3.7mm). The mean TPA largest at the level of T1 (35.8 ± 6.1mm) and progressively decreasing and slight increase at the level of T12 (6.3 ± 3.5mm). Men have larger pedicles as compared with women. It is recommended to use 4.5mm pedicle screw however it should be used with extra caution especially at mid thoracic level and among female patients.
Abstract: Knowledge of the morphometric measurements of Filipino thoracic spine pedicles would help the surgeons in determining the proper size and increase accuracy of pedicle screws placement during surgery to avoid complications. This study aims to measure the outer diameter, chord length and transverse angulation of the thoracic spine pedicles (T1-T12). ...
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Central Neurocytoma on the Treatment and Outcome: Clinical Case Series Report
Kai-Jie Chia,
Cheng-Shyuan Rau,
Wu-Fu Chen,
Li-Han Lin,
Jui-Wei Lin,
Jih-Jun Ho
Issue:
Volume 6, Issue 1, June 2022
Pages:
23-27
Received:
5 May 2022
Accepted:
23 May 2022
Published:
31 May 2022
Abstract: Central neurocytoma (CN) is a rare and elusive tumor. The relationship between clinical outcome, tumor nature, and treatment of CN remains controversial. There were eight CN patients in our hospital from 2014 to 2021, and the prevalence of CN accounted for 0.36% of brain tumors. All of them underwent surgical removal, and two of them were combined with adjuvant radiotherapy (RT). We found that four patients without surgical complications had small tumors (33.0 ± 19.5 cm³), while the other four patients with surgical complications had larger tumors (89.8 ± 14.2 cm³). This suggests that large tumors are prone to surgical complications. One particular patient with a large CN suffered from intraventricular hemorrhage (IVH) caused by damage to the internal cerebral vein (figure 3). Regarding the effect of total removal (TR) and subtotal removal (SR) on surgical complications, two patients with large CNs died of IVH after TR. However, two other patients with large CN had a good prognosis after SR. Regarding the effect of adjuvant RT on surgical complications, one patient with large CN who received RT after SR and one patient with atypical small CN (MIB-1 LI 5.3%) who received RT after TR had a good prognosis without recurrence. Therefore, we suggest SR combined with RT for large CNs in the deep-site ventricle, TR for small CNs, and TR combined with RT for atypical small CNs. Clinical features of patients due to hydrocephalus subsided after surgical treatment. We also review literature and discuss clinical outcomes and treatment associated with CNs. Further investigation with a larger sample size is warranted for the optimal treatment.
Abstract: Central neurocytoma (CN) is a rare and elusive tumor. The relationship between clinical outcome, tumor nature, and treatment of CN remains controversial. There were eight CN patients in our hospital from 2014 to 2021, and the prevalence of CN accounted for 0.36% of brain tumors. All of them underwent surgical removal, and two of them were combined ...
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Cystic Glioblastoma of the Third Ventricle: Diagnostic Challenges and Poor Functional Outcome Related to Cystic Haemorrhage
Mohamed Awad Mohamed Hassan,
Emad Mohammad Abdelhamid Hassan,
Tariq Ahmed Saeed,
Ghalib Almesedin,
Saggaf Alawi Assaggaf
Issue:
Volume 6, Issue 1, June 2022
Pages:
28-31
Received:
27 May 2022
Accepted:
13 June 2022
Published:
21 June 2022
Abstract: Background: Glioblastoma multiforme (GBM) is the most common intra-axial primary brain tumour in adults, and prognosis is poor. Spontaneous haemorrhage is an uncommon but recognized initial presenting sign of primary brain tumour. Moreover, intra-cystic haemorrhage is frequent, further can affect functional outcome and even reducing survival duration. Most GBM tumours arise in the frontotemporal region, haemorrhagic cystic GBM arise in the third ventricle of the brain is very rare and create a diagnostic dilemma and surgical challenges. Third ventricular GBM can arise from structures on or near the third ventricle wall. Patients with massive intra-cystic haemorrhage can present with a wide spectrum of clinical signs and symptoms related to increased intracranial pressure (ICP), ranging from headache to sudden acute neurological deterioration, coma, and death. Acute deterioration frequently results from massive acute haemorrhage inside the cystic component leading to hydrocephalus, especially when the tumour mass obstructs the foramen of Monro. Due to high tumour-related mortality and sudden death related to acute hydrocephalus, A high index of suspicion is required to avoid misdiagnosis and delayed surgical treatment due to the atypical anatomic and radiologic presentation of cystic haemorrhagic GBM. This case presentation highlights the significant role of haemorrhage inside the GBM cystic component on both diagnosis and clinical course of the disease.
Abstract: Background: Glioblastoma multiforme (GBM) is the most common intra-axial primary brain tumour in adults, and prognosis is poor. Spontaneous haemorrhage is an uncommon but recognized initial presenting sign of primary brain tumour. Moreover, intra-cystic haemorrhage is frequent, further can affect functional outcome and even reducing survival durati...
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