This case report describes a 45-year-old woman who presented with a one-week history of swelling in her left mandibular angle and symptoms of vertigo, loss of consciousness, and sinus arrest. Testing revealed she had carotid sinus syndrome caused by a cystadenolymphoma tumor in her left parotid gland. Surgical removal of the 31x17mm tumor resulted in complete resolution of her symptoms and electrocardiogram abnormalities. To the authors' knowledge, this is the first reported case of carotid sinus syndrome secondary to cystadenolymphoma.
This document provides information on the diagnosis and management of cerebellopontine angle tumors, specifically vestibular schwannomas. It discusses the history, clinical presentation, imaging findings, classification systems, differential diagnosis, and treatment options including observation, surgery, and radiotherapy. Treatment is typically individualized based on factors like tumor size, hearing status, and patient preferences. A multidisciplinary approach is emphasized.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
A 30-year-old male presented with bilateral pyramidal tract signs, pseudobulbar palsy, and orogenital ulcers. MRI showed focal hypointense lesions in the pons, cerebral peduncle, and posterior internal capsule extending continuously and involving the corticospinal tract. The lesions enhanced with contrast, indicating vasogenic edema. This clinical and radiological picture is consistent with neuro-Behcet syndrome, a focal brainstem meningoencephalitis affecting the corticospinal tract bilaterally in a linear pattern from the midbrain downwards.
Nasopharyngeal carcinoma presenting as multiple cranial nerves involvementDr.sahar Alshamary
A 60-year-old man presented with pain in his left face and double vision for two months. Over the next week, he developed drooping of his left eyelid, difficulty swallowing, and nasal regurgitation of food. Examination found involvement of multiple cranial nerves on the left side. Imaging showed a mass in the left nasopharynx extending into surrounding areas. Biopsy indicated non-keratinizing undifferentiated nasopharyngeal carcinoma. The patient was diagnosed with stage 4 NPC and treated with chemotherapy and radiation.
Vertebral Osteomyelitis complicated with Epidural Absceses George Sapkas
This document discusses four cases of vertebral osteomyelitis complicated by epidural abscesses. It describes the patients' symptoms, diagnostic findings including MRI and lab results, and treatments which involved surgical drainage and decompression followed by long-term IV and oral antibiotics. The author concludes that early surgical treatment along with antibiotics can allow for full neurologic recovery, but delays in surgery are associated with higher morbidity and mortality.
A 54-year-old man presented with left hip pain and was found to have calcific tendonitis of the gluteus medius tendon near its insertion on the greater trochanter. MRI showed calcification and edema of the tendon. Calcific tendonitis is characterized by calcium hydroxyapatite deposition in tendons and is commonly seen in the rotator cuff or hip tendons. It causes pain exacerbated by activity and is typically self-limiting, treated with rest, ice, anti-inflammatories, or corticosteroid injections.
A 55-year-old male presented with headache and was found to have an intradiploic epidermoid cyst in
Enormous thoracic solitary fibrous tumour with inferior vena compression case...Abdulsalam Taha
This case report describes an extremely large solitary fibrous tumor (SFT) that arose in the thoracic cavity of a middle-aged male patient. The tumor filled the entire left hemithorax, displacing the heart and lungs to the right side and compressing the inferior vena cava. Though initially deemed inoperable, the tumor was successfully resected via median sternotomy. Histopathological examination confirmed the diagnosis of SFT. The report highlights the surgical management of this rare but potentially life-threatening intrathoracic tumor.
This document provides information on the diagnosis and management of cerebellopontine angle tumors, specifically vestibular schwannomas. It discusses the history, clinical presentation, imaging findings, classification systems, differential diagnosis, and treatment options including observation, surgery, and radiotherapy. Treatment is typically individualized based on factors like tumor size, hearing status, and patient preferences. A multidisciplinary approach is emphasized.
The document discusses juvenile nasopharyngeal angiofibroma (JNA), a benign but locally invasive vascular tumor that primarily affects adolescent males. It arises near the sphenopalatine foramen and can spread medially into the nasopharynx and laterally into surrounding structures. Presentation varies from nasal obstruction to cranial nerve palsies. Imaging shows a hypervascular mass often with bone erosion. Diagnosis is confirmed histologically. Staging guides surgical approach, with endoscopic resection increasingly used for early-stage tumors. Complete resection while preserving function is the goal.
A 30-year-old male presented with bilateral pyramidal tract signs, pseudobulbar palsy, and orogenital ulcers. MRI showed focal hypointense lesions in the pons, cerebral peduncle, and posterior internal capsule extending continuously and involving the corticospinal tract. The lesions enhanced with contrast, indicating vasogenic edema. This clinical and radiological picture is consistent with neuro-Behcet syndrome, a focal brainstem meningoencephalitis affecting the corticospinal tract bilaterally in a linear pattern from the midbrain downwards.
Nasopharyngeal carcinoma presenting as multiple cranial nerves involvementDr.sahar Alshamary
A 60-year-old man presented with pain in his left face and double vision for two months. Over the next week, he developed drooping of his left eyelid, difficulty swallowing, and nasal regurgitation of food. Examination found involvement of multiple cranial nerves on the left side. Imaging showed a mass in the left nasopharynx extending into surrounding areas. Biopsy indicated non-keratinizing undifferentiated nasopharyngeal carcinoma. The patient was diagnosed with stage 4 NPC and treated with chemotherapy and radiation.
Vertebral Osteomyelitis complicated with Epidural Absceses George Sapkas
This document discusses four cases of vertebral osteomyelitis complicated by epidural abscesses. It describes the patients' symptoms, diagnostic findings including MRI and lab results, and treatments which involved surgical drainage and decompression followed by long-term IV and oral antibiotics. The author concludes that early surgical treatment along with antibiotics can allow for full neurologic recovery, but delays in surgery are associated with higher morbidity and mortality.
A 54-year-old man presented with left hip pain and was found to have calcific tendonitis of the gluteus medius tendon near its insertion on the greater trochanter. MRI showed calcification and edema of the tendon. Calcific tendonitis is characterized by calcium hydroxyapatite deposition in tendons and is commonly seen in the rotator cuff or hip tendons. It causes pain exacerbated by activity and is typically self-limiting, treated with rest, ice, anti-inflammatories, or corticosteroid injections.
A 55-year-old male presented with headache and was found to have an intradiploic epidermoid cyst in
Enormous thoracic solitary fibrous tumour with inferior vena compression case...Abdulsalam Taha
This case report describes an extremely large solitary fibrous tumor (SFT) that arose in the thoracic cavity of a middle-aged male patient. The tumor filled the entire left hemithorax, displacing the heart and lungs to the right side and compressing the inferior vena cava. Though initially deemed inoperable, the tumor was successfully resected via median sternotomy. Histopathological examination confirmed the diagnosis of SFT. The report highlights the surgical management of this rare but potentially life-threatening intrathoracic tumor.
A Sinister Cause for Recurrent Syncope: Metastatic Parapharyngeal Space Tumorasclepiuspdfs
This case report describes a 68-year-old male who presented with recurrent syncope. Investigations revealed a large mass in his left parapharyngeal space compressing the carotid artery. Biopsy of the mass showed metastatic squamous cell carcinoma. Parapharyngeal space tumors can rarely cause syncope by compressing the carotid artery. Management is challenging in advanced cases. The patient was deemed unsuitable for treatment and received palliative care. This case highlights that in patients with recurrent syncope, parapharyngeal space tumors should be considered as a rare cause of compression of the carotid artery.
2 types (a) cellular NSIP
(b) Fibrotic NSIP (more common)
Fibrosis may involve alveolar septa, peribronchivascular interstitium, interlobular septa and visceral pleura.
Prognosis of fibrotic NSIP is worse , cellular NSIP has good prognosis.
HRCT finding may show both, airspace and interstitial patterns
This document discusses elective neurosurgery, specifically related to raised intracranial pressure and hydrocephalus. It begins by defining normal intracranial pressure and the Monroe-Kellie hypothesis. It then describes the causes, signs, symptoms and treatments of raised intracranial pressure, including medical options like mannitol and surgical options like craniotomy. The document also discusses the physiology of cerebrospinal fluid, the pathophysiology and types of hydrocephalus, investigations for hydrocephalus, and treatments like ventriculoperitoneal shunting, external drains, and endoscopic third ventriculostomy. Complications of treatments are also outlined.
This document discusses optimal CT techniques for evaluating diffuse lung disease and summarizes common radiologic signs. It recommends thin slices and special reconstruction to maximize lung detail. Careful attention to technique is needed to avoid motion artifacts. Specific descriptive terms enhance communication of findings. Common patterns include consolidation, ground-glass opacity, nodules, lines, and reticulation, which can indicate conditions like pneumonia, fibrosis and sarcoidosis depending on distribution and associated findings.
The CT scan shows bilateral, basal-predominant reticular opacities and honeycombing. Given the patient's history of asbestos exposure, though brief, the radiological findings are most consistent with a diagnosis of asbestosis. Asbestosis is the correct answer.
Thyroid swelling and management. In detail case discussion of thyroid swelling and its management. Details of examination as well included in the slide.
This document provides a summary of an presentation on approaches to interstitial lung disease (ILD) and updates in idiopathic pulmonary fibrosis (IPF) management. It begins with an introduction to ILDs and the pulmonary interstitium. It then covers the pathogenesis, classification, epidemiology, clinical assessment including history, exams, tests and tissue sampling, and radiological and pathological findings of ILDs. A significant portion discusses IPF specifically, including prognosis, guidelines for diagnosis, and medical therapies including pirfenidone and nintedanib which have been shown to reduce lung function decline in clinical trials. It concludes with experience using pirfenidone in Saudi Arabia.
The document discusses interstitial lung diseases (ILDs) and diffuse parenchymal lung diseases (DPLDs). It defines the lung interstitium and its three subdivisions. It describes the approach to evaluating ILDs, which involves radiologists, pathologists and pulmonologists. ILDs can be classified as those of known cause, idiopathic interstitial pneumonias, granulomatous diseases, and other rare forms. Common idiopathic interstitial pneumonias are also outlined. The document reviews clinical assessment of ILDs including history, exam, imaging and lung function testing.
Abstract
Carotid body tumors are rare, slow-growing, hypervascular neuroendocrine tumors. Although these tumors are benign neoplasm, they also have a tendency to malignant transformation. Complete surgical excision is the gold standard therapeutic modality for the treatment of carotid body tumors. Early surgical removal is recommended to prevent the development of larger and more advanced tumors, which are associated with higher morbidity and mortality. In this report, we presented three cases of carotid body tumor which were successfully treated with complete surgical excision, and reviewed the current literature. Furthermore, it was emphasized the necessity of early surgical management regardless of patient age and tumor size.
Carcinoma neuroendocrino del setto un rarissimo tumore nasaleMerqurio
This document presents a case report of a 73-year-old male with a rare small cell neuroendocrine carcinoma arising from the nasal septum. The patient presented with right-sided nasal obstruction, hyponasal speech, and recurrent epistaxis. Imaging showed a mass in the right nasal cavity extending to surrounding structures. The tumour was removed endoscopically and pathology confirmed a small cell neuroendocrine carcinoma. Due to the aggressive nature of this tumour type, the patient received combined chemotherapy and radiation in addition to surgery. At a 10-month follow-up the patient remained free of disease. Small cell neuroendocrine carcinoma of the nasal cavity is an extremely rare and aggressive tumour that is difficult to diagnose but requires
1) Congenital infections like CMV, toxoplasmosis, rubella and herpes can cause lesions such as periventricular calcifications, encephalomalacia, and migrational disorders on imaging.
2) Meningitis appears as leptomeningeal enhancement, effacement of cisterns, hydrocephalus, and may lead to complications like ventriculitis, cerebral abscesses, and infarcts.
3) Tubercular and fungal infections typically cause basilar exudates and popcorn-like calcifications in the basal cisterns on CT and basal meningeal enhancement on MRI.
1. A 50-year-old woman presents with progressive shortness of breath, cough, and low-grade fever after working in maintenance jobs around boats for many years. Chest x-ray shows bilateral lower lung zone reticular infiltrates and hazy angles.
2. The most likely diagnosis is silicosis given her occupational exposure history involving inorganic dust. Silicosis is associated with decreased diffusion on pulmonary function tests.
3. Key findings include bilateral lower lung zone reticular infiltrates on chest x-ray, occupational exposure history involving inorganic dust, and decreased diffusion capacity expected on pulmonary function tests.
The document discusses diffuse parenchymal lung disease (DPLD), also known as interstitial lung disease. It describes that DPLD encompasses hundreds of diseases that can be classified based on known versus unknown causes. Key points include that DPLD involves the lung interstitium and alveoli, and common patterns include reticulation, ground glass opacities, and nodules. Diagnosis involves considering clinical presentation, disease progression, radiological findings such as high-resolution CT, and histopathology from procedures like bronchoscopy. Common etiologies include connective tissue disease, hypersensitivity pneumonitis, drugs, radiation, and idiopathic interstitial pneumonias.
1) Pleural effusion results from perturbations in normal pleural fluid transport and can be caused by abnormalities in Starling's equilibrium, increased capillary and mesothelial permeability, or interference with lymphatic drainage.
2) Evaluation of a patient with a suspected pleural effusion involves a thorough history, physical exam, imaging such as chest x-ray or CT, and thoracentesis to analyze pleural fluid.
3) Analysis of pleural fluid aims to determine if the effusion is a transudate or exudate, which provides clues to potential underlying causes and guides further diagnostic testing and treatment.
Perineural invasion head neck cancers radiation therapy volumes and dosesDrVineetaGoel1
1. Perineural invasion (PNI) and perineural spread (PNS) in head and neck cancers can involve invasion of tumor cells along cranial nerves from the primary site.
2. PNI is classified based on extent from microscopic to gross involvement visible on imaging. Macroscopic PNI involving large nerves is considered a poor prognostic factor.
3. Magnetic resonance imaging is the preferred method to evaluate PNI and PNS with features including nerve enhancement, enlargement, and loss of perineural fat.
4. The trigeminal, facial, and vestibulocochlear nerves are most commonly involved. Treatment volumes in radiation therapy aim to cover the primary site, involved nerve,
- An 81-year-old man presented with abdominal pain and was found to have a bladder tumor, hydronephrosis, and small bowel obstruction. He underwent tumor removal but now has no urine output for 3 days.
- Exam finds decreased breath sounds on the right and abdominal distension. Labs show renal failure and congestive heart failure. A CT scan shows a right pleural effusion, retroperitoneal fluid, and bilateral hydronephrosis. Thoracentesis reveals exudative fluid.
- The findings are consistent with right-sided transudative pleural effusion and bilateral obstructive uropathy due to retroperitoneal fibrosis, likely from the patient's known bladder cancer.
This document discusses radiation-induced brachial plexus neuropathy (RIBPN), a delayed non-traumatic injury to the brachial plexus that can occur after radiation treatment to the chest, neck, or axilla. It presents the anatomy of the brachial plexus, risk factors for RIBPN, clinical presentation including pain and motor weakness, diagnostic methods such as MRI and electrophysiology, and management approaches focusing on pain relief, range of motion exercises, and surgery in severe cases. The goal of management is to provide pain relief, preserve muscle strength and range of motion, while motor weakness once established is unlikely to recover due to axonal damage from fibrosis and ischemia.
The document reports on 6 cases of pulmonary nocardiosis. All patients were immunocompromised and being treated with corticosteroids and/or immunosuppressive drugs. Clinical presentations ranged from malaise to respiratory failure. Radiological manifestations varied from solitary nodules to extensive cavitary lesions. Diagnosis was made by sputum culture in one case, open lung biopsy in 3 cases, and at autopsy in 2 cases. Three patients who received early sulfonamide therapy had their infections controlled.
Reversible hearing loss after 3D video-assisted marsupialization of several ...Michel Triffaux
Case report
Very few pediatric cases of arachnoid cyst of ponto-cerebellar angle are desribed in the literature. Only 4 are
described with hearing loss. It is a pathology which poses especially a problem of early diagnosis. In this paper
we describe the management of a 16-year-old patient with an arachnoid cyst of the cerebellopontine angle with
an isolated auditory deficit that was treated surgically. The follow up was marked by a Full recovery of hearing
after surgical treatment. Arachnoid cyst of the cerebellopontine angle is rare in the pediatric population, early
surgical management help to increase the chances of recovery.
This document presents a case report of a 55-year-old man with a sinonasal paraganglioma. He presented with episodes of epistaxis and a nasal mass. Imaging showed a mass involving the frontal sinus and ethmoids bilaterally. He underwent surgical excision of the mass along with cranialization of the frontal sinus using a fascia lata graft. Histopathology confirmed paraganglioma. The patient was followed for 1 year without signs of recurrence. Paragangliomas are rare tumors that can present in the sinonasal tract. Complete surgical excision is usually curative for benign cases.
A Sinister Cause for Recurrent Syncope: Metastatic Parapharyngeal Space Tumorasclepiuspdfs
This case report describes a 68-year-old male who presented with recurrent syncope. Investigations revealed a large mass in his left parapharyngeal space compressing the carotid artery. Biopsy of the mass showed metastatic squamous cell carcinoma. Parapharyngeal space tumors can rarely cause syncope by compressing the carotid artery. Management is challenging in advanced cases. The patient was deemed unsuitable for treatment and received palliative care. This case highlights that in patients with recurrent syncope, parapharyngeal space tumors should be considered as a rare cause of compression of the carotid artery.
2 types (a) cellular NSIP
(b) Fibrotic NSIP (more common)
Fibrosis may involve alveolar septa, peribronchivascular interstitium, interlobular septa and visceral pleura.
Prognosis of fibrotic NSIP is worse , cellular NSIP has good prognosis.
HRCT finding may show both, airspace and interstitial patterns
This document discusses elective neurosurgery, specifically related to raised intracranial pressure and hydrocephalus. It begins by defining normal intracranial pressure and the Monroe-Kellie hypothesis. It then describes the causes, signs, symptoms and treatments of raised intracranial pressure, including medical options like mannitol and surgical options like craniotomy. The document also discusses the physiology of cerebrospinal fluid, the pathophysiology and types of hydrocephalus, investigations for hydrocephalus, and treatments like ventriculoperitoneal shunting, external drains, and endoscopic third ventriculostomy. Complications of treatments are also outlined.
This document discusses optimal CT techniques for evaluating diffuse lung disease and summarizes common radiologic signs. It recommends thin slices and special reconstruction to maximize lung detail. Careful attention to technique is needed to avoid motion artifacts. Specific descriptive terms enhance communication of findings. Common patterns include consolidation, ground-glass opacity, nodules, lines, and reticulation, which can indicate conditions like pneumonia, fibrosis and sarcoidosis depending on distribution and associated findings.
The CT scan shows bilateral, basal-predominant reticular opacities and honeycombing. Given the patient's history of asbestos exposure, though brief, the radiological findings are most consistent with a diagnosis of asbestosis. Asbestosis is the correct answer.
Thyroid swelling and management. In detail case discussion of thyroid swelling and its management. Details of examination as well included in the slide.
This document provides a summary of an presentation on approaches to interstitial lung disease (ILD) and updates in idiopathic pulmonary fibrosis (IPF) management. It begins with an introduction to ILDs and the pulmonary interstitium. It then covers the pathogenesis, classification, epidemiology, clinical assessment including history, exams, tests and tissue sampling, and radiological and pathological findings of ILDs. A significant portion discusses IPF specifically, including prognosis, guidelines for diagnosis, and medical therapies including pirfenidone and nintedanib which have been shown to reduce lung function decline in clinical trials. It concludes with experience using pirfenidone in Saudi Arabia.
The document discusses interstitial lung diseases (ILDs) and diffuse parenchymal lung diseases (DPLDs). It defines the lung interstitium and its three subdivisions. It describes the approach to evaluating ILDs, which involves radiologists, pathologists and pulmonologists. ILDs can be classified as those of known cause, idiopathic interstitial pneumonias, granulomatous diseases, and other rare forms. Common idiopathic interstitial pneumonias are also outlined. The document reviews clinical assessment of ILDs including history, exam, imaging and lung function testing.
Abstract
Carotid body tumors are rare, slow-growing, hypervascular neuroendocrine tumors. Although these tumors are benign neoplasm, they also have a tendency to malignant transformation. Complete surgical excision is the gold standard therapeutic modality for the treatment of carotid body tumors. Early surgical removal is recommended to prevent the development of larger and more advanced tumors, which are associated with higher morbidity and mortality. In this report, we presented three cases of carotid body tumor which were successfully treated with complete surgical excision, and reviewed the current literature. Furthermore, it was emphasized the necessity of early surgical management regardless of patient age and tumor size.
Carcinoma neuroendocrino del setto un rarissimo tumore nasaleMerqurio
This document presents a case report of a 73-year-old male with a rare small cell neuroendocrine carcinoma arising from the nasal septum. The patient presented with right-sided nasal obstruction, hyponasal speech, and recurrent epistaxis. Imaging showed a mass in the right nasal cavity extending to surrounding structures. The tumour was removed endoscopically and pathology confirmed a small cell neuroendocrine carcinoma. Due to the aggressive nature of this tumour type, the patient received combined chemotherapy and radiation in addition to surgery. At a 10-month follow-up the patient remained free of disease. Small cell neuroendocrine carcinoma of the nasal cavity is an extremely rare and aggressive tumour that is difficult to diagnose but requires
1) Congenital infections like CMV, toxoplasmosis, rubella and herpes can cause lesions such as periventricular calcifications, encephalomalacia, and migrational disorders on imaging.
2) Meningitis appears as leptomeningeal enhancement, effacement of cisterns, hydrocephalus, and may lead to complications like ventriculitis, cerebral abscesses, and infarcts.
3) Tubercular and fungal infections typically cause basilar exudates and popcorn-like calcifications in the basal cisterns on CT and basal meningeal enhancement on MRI.
1. A 50-year-old woman presents with progressive shortness of breath, cough, and low-grade fever after working in maintenance jobs around boats for many years. Chest x-ray shows bilateral lower lung zone reticular infiltrates and hazy angles.
2. The most likely diagnosis is silicosis given her occupational exposure history involving inorganic dust. Silicosis is associated with decreased diffusion on pulmonary function tests.
3. Key findings include bilateral lower lung zone reticular infiltrates on chest x-ray, occupational exposure history involving inorganic dust, and decreased diffusion capacity expected on pulmonary function tests.
The document discusses diffuse parenchymal lung disease (DPLD), also known as interstitial lung disease. It describes that DPLD encompasses hundreds of diseases that can be classified based on known versus unknown causes. Key points include that DPLD involves the lung interstitium and alveoli, and common patterns include reticulation, ground glass opacities, and nodules. Diagnosis involves considering clinical presentation, disease progression, radiological findings such as high-resolution CT, and histopathology from procedures like bronchoscopy. Common etiologies include connective tissue disease, hypersensitivity pneumonitis, drugs, radiation, and idiopathic interstitial pneumonias.
1) Pleural effusion results from perturbations in normal pleural fluid transport and can be caused by abnormalities in Starling's equilibrium, increased capillary and mesothelial permeability, or interference with lymphatic drainage.
2) Evaluation of a patient with a suspected pleural effusion involves a thorough history, physical exam, imaging such as chest x-ray or CT, and thoracentesis to analyze pleural fluid.
3) Analysis of pleural fluid aims to determine if the effusion is a transudate or exudate, which provides clues to potential underlying causes and guides further diagnostic testing and treatment.
Perineural invasion head neck cancers radiation therapy volumes and dosesDrVineetaGoel1
1. Perineural invasion (PNI) and perineural spread (PNS) in head and neck cancers can involve invasion of tumor cells along cranial nerves from the primary site.
2. PNI is classified based on extent from microscopic to gross involvement visible on imaging. Macroscopic PNI involving large nerves is considered a poor prognostic factor.
3. Magnetic resonance imaging is the preferred method to evaluate PNI and PNS with features including nerve enhancement, enlargement, and loss of perineural fat.
4. The trigeminal, facial, and vestibulocochlear nerves are most commonly involved. Treatment volumes in radiation therapy aim to cover the primary site, involved nerve,
- An 81-year-old man presented with abdominal pain and was found to have a bladder tumor, hydronephrosis, and small bowel obstruction. He underwent tumor removal but now has no urine output for 3 days.
- Exam finds decreased breath sounds on the right and abdominal distension. Labs show renal failure and congestive heart failure. A CT scan shows a right pleural effusion, retroperitoneal fluid, and bilateral hydronephrosis. Thoracentesis reveals exudative fluid.
- The findings are consistent with right-sided transudative pleural effusion and bilateral obstructive uropathy due to retroperitoneal fibrosis, likely from the patient's known bladder cancer.
This document discusses radiation-induced brachial plexus neuropathy (RIBPN), a delayed non-traumatic injury to the brachial plexus that can occur after radiation treatment to the chest, neck, or axilla. It presents the anatomy of the brachial plexus, risk factors for RIBPN, clinical presentation including pain and motor weakness, diagnostic methods such as MRI and electrophysiology, and management approaches focusing on pain relief, range of motion exercises, and surgery in severe cases. The goal of management is to provide pain relief, preserve muscle strength and range of motion, while motor weakness once established is unlikely to recover due to axonal damage from fibrosis and ischemia.
The document reports on 6 cases of pulmonary nocardiosis. All patients were immunocompromised and being treated with corticosteroids and/or immunosuppressive drugs. Clinical presentations ranged from malaise to respiratory failure. Radiological manifestations varied from solitary nodules to extensive cavitary lesions. Diagnosis was made by sputum culture in one case, open lung biopsy in 3 cases, and at autopsy in 2 cases. Three patients who received early sulfonamide therapy had their infections controlled.
Reversible hearing loss after 3D video-assisted marsupialization of several ...Michel Triffaux
Case report
Very few pediatric cases of arachnoid cyst of ponto-cerebellar angle are desribed in the literature. Only 4 are
described with hearing loss. It is a pathology which poses especially a problem of early diagnosis. In this paper
we describe the management of a 16-year-old patient with an arachnoid cyst of the cerebellopontine angle with
an isolated auditory deficit that was treated surgically. The follow up was marked by a Full recovery of hearing
after surgical treatment. Arachnoid cyst of the cerebellopontine angle is rare in the pediatric population, early
surgical management help to increase the chances of recovery.
This document presents a case report of a 55-year-old man with a sinonasal paraganglioma. He presented with episodes of epistaxis and a nasal mass. Imaging showed a mass involving the frontal sinus and ethmoids bilaterally. He underwent surgical excision of the mass along with cranialization of the frontal sinus using a fascia lata graft. Histopathology confirmed paraganglioma. The patient was followed for 1 year without signs of recurrence. Paragangliomas are rare tumors that can present in the sinonasal tract. Complete surgical excision is usually curative for benign cases.
Abstract: We report a case of sinonasal paraganglioma presenting with episodes of epistaxis. A 55 year old male presented with a
nasal mass. It is an uncommon site of presentation and in an uncommon age group. A high grade of suspicion is required to diagnose
sino nasal paraganglioma. However, CT Scan and histopathology helps in early diagnosis and treatment. Surgical excision done with
cranialization of frontal sinus with fascia lata graft, followed up for 1 year without any evidence of disease recurrence.
Keywords: Sinonasal; Paraganglioma; Fascia Lata.
This document reports a case study of a 55-year-old man diagnosed with sinonasal paraganglioma, a rare tumor arising from paraganglionic tissue. The man presented with episodes of epistaxis (nosebleeds) and a nasal mass. Imaging including CT and MRI scans confirmed a mass involving the frontal and ethmoid sinuses extending into surrounding areas. The tumor was surgically excised and pathology confirmed paraganglioma. The man recovered well after surgery without signs of recurrence after one year of follow up. Paragangliomas are rare tumors in the nasal cavity that can be difficult to diagnose but surgery is typically curative for benign cases.
- Cavernous sinus thrombosis is a serious condition caused by the formation of blood clots in the cavernous sinus due to bacterial infections spreading from the face or skull.
- It affects cranial nerves 3, 4, 5, and 6 which pass through the cavernous sinus, and can cause symptoms like headaches, eye problems, and facial swelling or numbness.
- Risk factors include chronic sinusitis and diabetes. Treatment focuses on aggressive antibiotics, anticoagulants, and sometimes surgery to drain pus and remove clots.
Unusual Presentation of Tuberculosis in Head and Neck RegionAakanksha Rathor
The document reports on 3 cases of unusual presentations of tuberculosis in the head and neck region, including intraparotid lymphadenitis, branchial cyst tuberculosis, and jugular chain lymphadenitis. The cases were diagnosed through various clinical examinations, imaging studies, and histopathological analysis. All 3 cases were successfully treated with antitubercular medication alone or in combination with surgery, and showed no signs of recurrence or non-compliance to treatment.
Unusual Presentation of Tuberculosis in Head and Neck RegionSachender Tanwar
Abstract: 3 case reports of tuberculosis at uncommon sites within head and neck region. Diagnosed on the basis of various clinical,
histopathological and imaging studies. Managed either with DOTS regimen only or both surgery & antitubercular treatment. None of
the cases showed non-compliance to treatment or recurrence of disease.
Keywords: tuberculosis, intra parotid lymphadenitis, branchial cyst, jugular chain lymphadenitis level II-III.
Carcinoma neuroendocrino del setto un rarissimo tumore nasaleMerqurio
This document presents a case report of a 73-year-old male with a rare small cell neuroendocrine carcinoma arising from the nasal septum. The patient presented with right-sided nasal obstruction, hyponasal speech, and recurrent epistaxis. Imaging showed a mass in the right nasal cavity extending to surrounding areas. The tumour was removed endoscopically and found to be a small cell neuroendocrine carcinoma based on histology and immunohistochemistry. Due to the aggressive nature of this tumour type, the patient received combined chemotherapy and radiation in addition to surgery. At a 10-month follow-up the patient remained free of disease. Small cell neuroendocrine carcinoma of the nasal cavity is an extremely rare and aggressive
This document discusses the anatomy, staging, treatment and techniques for carcinoma of the nasopharynx. It describes the parapharyngeal space and lymphatic drainage of the nasopharynx. It discusses the AJCC staging system and Ho's staging system. It covers treatment techniques including two-field and three-field approaches, doses used, treatment volumes, nodal volumes, planning and field matching considerations.
A 55-year-old male presented to the emergency department with confusion, irritability, and dyspnea. His medical history included diabetes, hypertension, possible COPD, and a prior myocardial infarction. On examination, he had tachycardia, oxygen saturation of 50%, and a blood pressure of 130/80 mmHg. He was intubated for ventilation. An electrocardiogram showed abnormal findings. An echocardiogram found an ejection fraction of 23%. The patient's electrocardiogram and condition are discussed in detail over multiple messages.
Tips and tricks to site and maintain nerve cathetersAmit Pawa
This lecture was given on Friday 13th September 2019 at the annual congress of the European Society of Regional Anaesthesia in Bilbao and Spain. The talk was also contributed to by the Twitter Community. Strategies and techniques to site, secure and maintain perineural nerve catheters is discussed
Late onset jugular foramen syndrome following head traumaNeuro Surgeon
A 50-year-old man presented with sudden onset voice changes, nasal regurgitation, nausea and vomiting one day after suffering a severe head injury from a motor vehicle accident. Imaging showed resolving brain contusions and absence of blood flow in the left transverse and sigmoid sinuses, suggesting sinus thrombosis. Examination revealed palsies of the 9th, 10th and 11th cranial nerves on the left side. Further imaging confirmed sinus thrombosis and a skull fracture crossing the left jugular foramen. The patient was managed conservatively and symptoms resolved within a month. Traumatic dural venous sinus thrombosis can occur after head injury via direct compression or endothelial damage causing coagulation. It presents a management challenge due to risk of hemor
Late onset jugular foramen syndrome following head traumaNeuro Surgeon
Recklinghausen's disease. Neurological examination revealed spastic quadriparesis, prominent in the left extremities. Posterior column sensations were lost in all four limbs. Deep tendon reflexes were exaggerated in all four limbs. A positive Hoffman s and Babinsky signs and sign were present bilaterally. Gait was broad-based due to spasticity. Difficulty in urination was present .MRI of cervical spine was done at some other institute revealed a large well defined homogenously enhancing intradural extramedullary mass at C1-2 level on left side markedly compressing the cord, there was associated cord edema at adjacent cervical levels(fig.1&2). A provisional diagnosis of schwannoma or neurofibroma was kept since there was no dural tail or broad based attachment of tumor to dura.
Patient was advised surgical removal of tumour . Tumor was approached via midline incision in neck and C-1 to C-3 laminectomy was done. Dura was opened under microscope and tumor was found on left side and whole of the tumor was intra arachnoidal. To our surprise though tumor was mainly extra medullary on left side ,it had an intra-medullary extension. Extramedullary component was completely removed followed by intatumoral decompression of intra medullary part.Capsule of intramedullary component was densely adherent to spinal cord and small amount of tumor tissue had to be left behind to avoid post operative neurological deficit(fig.4). Duraplasty was done. In the postoperative period the power of the patient improved gradually and by the end of the first week she could walk without support and at the end of one month power in all four limbs was 5/5 , though spasticity remained in all four limbs. Her gait remain broad based and there is clumsiness while walking.
DISCUSSION
Intramedullary schwannomas are rare tumors . The first surgical description of a spinal tumor was made in 1888 by Sir Victor Horsley(3). In 1907 Von Eiselberg published the successful resection of an intramedullary neurofibrosarcoma. First intramedullary schwannoma was reported by Kernohanin1952 though Penfield had already described an intramedullary lesion with schwannoma characteristics in 1932(4).
We found 52 cases in the literature, in addition to our case. Of these cases only three have been reported as having both intramedullary and extramedullary component . Gorman etal., have reported the extramedullary component to be an exophytic extension of the intramedullary tumor from the enlarged spinal cord(5).
Mean age at presentation of these lesions is 40-years . They are usually single lesions affecting the cervical spinal cord (63%), the thoracic spinal cord (26%) and the lumbar spinal cord (11%). They have a slow growth pattern and because of this the average interval between first symptoms and diagnosis is 28.2 months (from six months to 20 years)(6). The most described clinical manifestation is the pyramidal syndrome followed by sensitivity complaints and sphincter dysfunctio
Late onset jugular foramen syndrome following head traumaNeuro Surgeon
A 50-year-old man presented with sudden onset voice changes, nasal regurgitation, nausea, and vomiting one day after suffering a severe head injury from a motor vehicle accident. Imaging showed resolving brain contusions and absence of blood flow in the left transverse and sigmoid sinuses, suggesting sinus thrombosis. Examination revealed palsies of the ninth, tenth, and eleventh cranial nerves on the left side. Head trauma can cause sinus thrombosis by direct compression or endothelial damage, leading to clot formation. The patient's symptoms resolved over one month with conservative management. Traumatic dural venous sinus thrombosis is a known complication of head injuries involving skull fractures near sinuses.
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2. A left parotidectomy was performed. The resected
gland was a hard mass, which had spread over the bifur-
cation of the left carotid artery without invading the ves-
sel wall itself. The tumor was oval-shaped, encapsulated,
and partially nodular without any regional lymph gland
involvement. Upon opening the mass viscous, white-
colored fluid was released (Figure 2A/B).
The pathology report showed a lymphoid tissue with
multifocal double-row hypereosinophilic epithelium with
retention of thickened secretions in the lumen as well as
squamous cell metaplasia consistent with typical parotid
gland cystadenolymphoma (Figure 3A/B).
The patient started ambulating from the second post-
operative day without any symptoms of vertigo and con-
sciousness. 24-hour Holter monitoring was repeated on
three occasions at weekly intervals and revealed regular
sinus rhythm at a rate of 80 to 90 per minute. 6 months
postoperatively, the patient was asymptomatic.
Discussion and conclusion
The carotid sinus, located just superior to the bifurcation
of the carotid artery controls the heart rate and blood
pressure via receptors located within the arterial adventi-
tia. The afferent limb of the carotid sinus reflex begins
with these receptors [3]. Myelinated nerve fibers emerge
from these menisci as spiral fibers and from the sinus
nerve of Hering, a branch of the glossopharyngeal nerve.
Other fibers may follow the hypoglossal nerve, vagus
nerve or cervical sympathetic nerves to the medulla. The
efferent fibers descend in the vagus and cervical sympa-
thetic nerves to the cardioinhibitory and vasomotor cen-
ters [4,5]. The carotid sinus syndrome consists of a
cardiovascular symptom complex resulting from excita-
tion of a hyperactive carotid sinus reflex. Weiss and Baker
[2] classified three types of responses leading to carotid
sinus stimulation. Cardioinhibitory response, which is
expressed as bradycardia and asystole, vasodepressor re-
sponse, characterized by profound hypotension without
bradycardia, and cerebral response, which is an interfer-
ence with the circulation of the ipsilateral cerebral hemi-
sphere circulation [6]. The pathophysiology of carotid
sinus syndrome secondary to head and neck malignancy is
not well understood. Local pathologic conditions adjacent
to the carotid sinus such as enlarged lymph nodes, oper-
ation scars, and mechanical pressure by a mass on carotid
sinus or by actual invasion of the carotid sinus, sinus
nerve or glossopharyngeal nerve by tumor have been pos-
tulated to produce carotid sinus syndrome [1,4,7,8].
The tumor may cause either a spontaneous abnormal af-
ferent discharge in the damaged nerve itself or may lead
to ephaptic conduction, either between glossopharyngeal
Figure 1 Computerized tomography (CT) at the level of the
submandibular area demonstrating the mass of the left parotid
gland extending into the carotid space.
Figure 2 A/B: 2A:The tumor was oval-shaped, encapsulated,
and partially nodular without any regional lymph gland
involvement. 2B: Upon opening the mass viscous, white-colored
fluid was released.
Noroozi et al. Head & Face Medicine 2012, 8:31 Page 2 of 4
http://www.head-face-med.com/content/8/1/31
3. efferent motor fibers and afferent sinus sensory fibers or
between the glossopharyngeal nerve and other nearby
nerves, inducing an abnormally strong carotid sinus reflex.
It also been postulated that compression of the nerve out-
side of the carotid sinus reflex arc, such as the glossopha-
ryngeal nerve, can cause carotid sinus syndrome [9-13].
It is more likely that head and neck tumors cause syn-
cope by involvement of the glossopharyngeal or vagus
nerve in those patients in whom carotid sinus massage
does not induce syncope.
The majority of reports of carotid sinus syndrome
associated with head and neck malignancy relate to ex-
tensive nodal involvement in the neck [14].
The immediate treatment of carotid sinus syndrome
includes anticholinergic medications and cardiac pacing.
Surgery is reserved for those who fail medical therapy
[15]. Radiation therapy is occasionally beneficial [16].
In our presented case the disturbing symptoms of ver-
tigo, consciousness and sinus arrest, all disappeared fol-
lowing resection of the parotid tumor. We postulate that
the tumor produced sustained compression on the carotid
sinus resulting in carotid sinus syndrome. The patient was
followed postoperatively for 6 months without any clinical
symptoms. In summary, this is the first report of carotid
sinus syndrome exacerbated by a benign parotid tumor
and is made more remarkable here as a possible differen-
tial diagnosis after clarification of all possible causes. Early
diagnosis and immediate management can minimize com-
plications. Resection of the tumor resulted in amelioration
of symptoms and disappearance of electrocardiography
abnormalities.
Consent statement
Written informed consent was obtained from the patient
for publication of this case report and accompanying
images. A copy of the written consent is available for re-
view by the Editor-in-Chief of this journal.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
NN, AM, FH, TB, DR, MG and AG conceived of the study and participated in
its design and coordination. NN and AM drafted the manuscript and
contributed equally to this work. NN, AM, MG and AG were involved in
revising the manuscript. All authors read and approved the final manuscript.
Author details
1
Department of Oral, Maxillofacial and Plastic Facial Surgery, University
Hospital RWTH-Aachen, Pauwelsstraße 30, Aachen 52074, Germany. 2
Institute
of Pathology, University Hospital RWTH-Aachen, Aachen, Germany.
3
Department of Oral, Maxillofacial and Plastic Facial Surgery, Heinrich-Braun
Hospital Zwickau, Zwickau, Germany.
Received: 15 October 2012 Accepted: 12 November 2012
Published: 14 November 2012
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doi:10.1186/1746-160X-8-31
Cite this article as: Noroozi et al.: Carotid sinus syndrome as the
presenting symptom of cystadenolymphoma. Head & Face Medicine 2012
8:31.
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