Remote Cerebellar Hemorrhage Following Lumboperitoneal Shunt Insertion: A Rare Case Report.
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ABSTRACT:
SUBMITTER: Ayvalık F
PROVIDER: S-EPMC5553480 | biostudies-other | 2016 Oct
REPOSITORIES: biostudies-other
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Project description:Remote Cerebellar Hemorrhage is a rare entity that manifests spontaneously after supratentorial craniotomy and spinal surgeries. We present a 53-year-old male who was admitted due to subdural hematoma along the left frontoparietotemporal convexity. After treatment of the subdural hematoma with craniotomy and evacuation, he developed remote cerebellar hemorrhage 1 week later. Brain computed tomography demonstrated the zebra sign. Follow-up imaging showed complete recovery without any neurologic symptoms or signs.
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Project description:Background Cerebellar glioblastoma multiforme (GBM) is rare and presents with increased intracranial pressure and cerebellar signs. The recommended treatment is radical resection, if possible, with radiation and chemotherapy. Clinical Presentation A 53-year-old man presented with hypertensive cerebellar bleeding and a 2-day history of severe headaches, nausea, vomiting, gait instability, and elevated blood pressure. Computed tomography (CT) showed a left cerebellar hematoma with no obstruction of cerebrospinal fluid and no hydrocephalus. CT angiography showed no signs of pathologic blood vessels in the posterior cranial fossa. The patient was observed in the hospital and discharged. Subsequent CT showed complete hematoma resorption. Two weeks later, he developed headaches, nausea, and worsening cerebellar symptoms. Magnetic resonance imaging (MRI) showed a 4-cm diameter tumor in the left cerebellar hemisphere where the hemorrhage was located. The tumor was radically resected and diagnosed as GBM. The patient underwent radiation and chemotherapy. At a follow-up of 1.5 years, MRIs showed no tumor recurrence. Conclusion Hypertensive cerebellar hemorrhage may be the first presentation of underlying tumor, specifically GBM. Patients undergoing surgery for cerebellar hemorrhage should have clot specimens sent for histologic examination and have pre- and postcontrast MRIs. Patients not undergoing surgery should have MRIs done after hematoma resolution to rule out underlying tumor.
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Project description:BackgroundDiaphragmatic myoclonus is a rare motor disorder that affects muscle tone. It is characterized by involuntary movements of the abdominal wall and rhythmic, repetitive contractions of the accessory or respiratory muscles, all of which are innervated by the cervical nerve roots.Case descriptionWe reviewed the case of a 57-year-old male patient who underwent surgery for a left cerebellar hemorrhage. He exhibited persistent myoclonus in the palate, jaw, and thoracoabdominal region. Following treatment, there was a significant reduction in flutter amplitude in these areas.ConclusionThe clinical rarity and variability of presentations often make diagnosis challenging and delayed. It is believed that this condition stems from abnormal excitation within the central nervous system or neural pathways that involve the phrenic nerve. Another potential mechanism is the direct irritation of the diaphragm. Ultrasound, chest fluoroscopy, and electromyography (EMG) can support the diagnosis. Various pharmacological and surgical treatments have been tried, yet specific treatment guidelines are still lacking.
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Project description:Renal leiomyosarcomas (LMS) are extremely rare neoplasms with aggressive behaviour and poor survival prognosis. The most frequent somatic events in leiomyosarcomas are mutations in TP53, RB1, ATRX and PTEN genes, chromosomal instability and chromoanagenesis. By using chromosomal microarray analysis we identified monosomy of chromosomes 3 and 11, gain of Xp (ATRX) arm and three chromoanasynthesis regions (6q21-q27, 7p22.3-p12.1 and 12q13.11-q21.2), with MDM2 and CDK4 oncogenes copy number gains, whereas no CNVs or tumor specific SNVs in TP53, RB1 and PTEN genes were observed.
2020-06-04 | GSE151766 | GEO
Project description:Introduction and importance Subarachnoid hemorrhage (SAH) is mostly associated with head trauma. Non-traumatic subarachnoid hemorrhage is mostly due to vascular abnormalities: either hemorrhage from ruptured aneurysm or bleeding from arteriovenous malformation. Aneurysmal hemorrhage is the biggest cause in non-traumatic cases. Warfarin is associated with cerebral intraparenchymal hemorrhage, but it is rarely associated with SAH. Case presentation Here, we report the case of a 45-year-old male patient who was admitted to the neurology ward of our hospital due to acute ischemic stroke. The patient was treated with a vitamin K antagonist (warfarin). However, on the third day, his condition deteriorated (his GCS regressed from 11/15 to 5/15). His pupils were anisocoric. Brain CT showed extensive subarachnoid hemorrhage without intraparenchymal involvement. Cerebral magnetic resonance angiography ruled out aneurysmal rupture. The patient was intubated and transferred to the intensive care unit. Due to his poor condition, neurosurgical intervention could not be done. The patient was managed conservatively, but the patient passed away 4 days later in the intensive care unit. Clinical discussion Non-traumatic SAH is mostly caused by aneurysmal rupture. Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event. Here we present a young male patient with an isolated warfarin-induced SAH. Conclusion Warfarin is rarely associated with isolated subarachnoid hemorrhage. This case highlights a young male patient with spontaneous SAH after warfarin therapy for acute ischemic stroke. Aneurysmal rupture and trauma should be excluded before a diagnosis of warfarin-induced SAH is made. Highlights • Non-traumatic subarachnoid hemorrhage (SAH) is mostly caused by aneurysmal rupture.• Warfarin increases the risk of intracranial hemorrhage and mostly causes intraparenchymal hemorrhage. Isolated warfarin-related SAH without parenchymal involvement is a rare event.• Here we present a young male patient with isolated SAH due to warfarin treatment for acute ischemic stroke.
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Project description:Study Design Case report. Objective To report a case of remote cerebellar hemorrhage (RCH) without intraoperative dural tear after revision lumbar spine surgery. RCH is a rare postoperative complication following spine surgery. RCH has previously been reported only in cases with intraoperative dural tear or durotomy. Methods Case report and literature review. Results A 58-year-old woman underwent removal of L4-S1 posterior spinal instrumented fusion (PSIF) implants and L3-L4 decompressive laminectomy with PSIF. There was no intraoperative dural tear. After doing well initially, the patient developed new neurologic symptoms and was found to have RCH. Lumbar spine magnetic resonance imaging (MRI) demonstrated a large dural defect. After repair of the dura, the patient had dramatic improvement of her neurologic symptoms. At 1-year follow-up, the patient continued to have no neurologic sequelae. Conclusion This report demonstrates that RCH can occur without intraoperative dural tear. Although rare, any patient with new onset of declining neurologic symptoms following spine surgery should have a brain MRI and should have RCH on the differential diagnosis.
| S-EPMC4671890 | biostudies-other
Project description:Delayed intracerebral hemorrhage after ventriculoperitoneal (VP) shunt insertion is rare and has not been well investigated previously. Its characteristics is still unknown.We reported 12 patients with delayed intracerebral hemorrhage after VP shunt to investigate the potential risk factors and the outcome.12 patients (1.59%) of all the 754 hydrocephalus had delayed intracerebral hemorrhage after VP shunt insertion. 4 patients were women and 8 patients were men, ranging in age from 50 to 76 years. The delayed cerebral hemorrhage from day 3 to day 7 post operation was diagnosed by repeated CT. The delayed intracerebral hemorrhage was significantly related to age, prior craniotomy operation history and manipulation of valve system (3-7 days). Neither gender sexuality nor potential risk factors for postoperative hemorrhage (including anticoagulation/antiplatelet status, liver disease, diabetes, hypertension), time of shunt attempt affected the happen of delayed intracerebral hemorrhage.The clinical characteristics including sex, age, anticoagulation/antiplatelet status, liver disease, diabetes, hypertension, craniotomy operation history, manipulation of valve system and time of shunt attempt of 754 patients who were surgically treated of VP shunt at the first affiliated hospital of Soochow University between 2007 and 2013 were reviewed retrospectively. The potential risk factors of the delayed intracerebral hemorrhage were statistically analyzed.This study summarizes the presentation and outcome of a series of 12 patients with delayed intracerebral hemorrhage after VP shunt. Age ≥ 60 years, prior craniotomy operation and manipulation of the valve system are statistically significant to the delayed hematoma secondary to VP shunt.
| S-EPMC5522098 | biostudies-other
Project description:Introduction Abiotrophia defectiva is an uncommon and potentially severe cause of bacterial meningitis that can be seen in the setting of neurosurgical procedures. We describe here a case of A. defectiva meningitis in a patient with VP shunt revision. Case report The patient is a 59-year-old female with VP shunt placed several years prior in the setting of normal pressure hydrocephalus. She underwent successful shunt repair following worsening gait abnormalities. On post-operative day 8 she was brought to the emergency room with fevers, photophobia and altered mentation. CSF cultures returned positive for A. defectiva and she was treated with intravenous vancomycin. Due to the presence of retained hardware she was discharged on chronic suppressive therapy with oral amoxicillin. Conclusion This case illustrates A. defectiva as a cause of bacterial meningitis following neurosurgical intervention. It is important to consider this fastidious organism and tailor antimicrobial therapy appropriately to prevent significant morbidity and mortality. As was the case with our patient, suppressive therapy may be warranted in setting of retained hardware.
| S-EPMC9931922 | biostudies-literature
Project description:Background. First described in 2005, inverted takotsubo is one of the four stress-induced cardiomyopathy patterns. It is rarely associated with subarachnoid hemorrhage but was not previously reported after intraparenchymal bleeding. Purpose. We reported a symptomatic case of inverted takotsubo pattern following a cerebellar hemorrhage. Case Report. A 26-year-old woman presented to the emergency department with sudden headache and hemorrhage of the posterior fossa was diagnosed, probably caused by a vascular malformation. Several hours later, she developed acute pulmonary edema due to acute heart failure. Echocardiography showed left ventricular dysfunction with hypokinetic basal segments and hyperkinetic apex corresponding to inverted takotsubo. Outcome was spontaneously favorable within a few days. Conclusion. Inverted takotsubo pattern is a stress-induced cardiomyopathy that could be encountered in patients with subarachnoid hemorrhage and is generally of good prognosis. We described the first case following a cerebellar hematoma.
| S-EPMC4006561 | biostudies-literature
Project description:Introduction:Subarachnoid Hemorrhage (SAH) is caused by an aneurysmatic origin in 80% of cases. In the adult population, the risk of shunt dysfunction is about 16% in the first year, with proximal mechanical obstruction being the most frequent cause. Case report:An 81-year-old man with a history of shunt system placement presented among clinical data of shunt dysfunction. The brain Computed Tomography (CT) showed dilation of the ventricular system, with no other associated injury. The cause of the dysfunction was a SAH determined by a lumbar puncture (LP) study. We performed an angiography reporting 3 aneurysms. Discussion:The risk of shunt dysfunction at one year is 40% and at two years, the risk ups to 53% with obstruction of the system and infection being the two principal causes. The usefulness of a lumbar puncture for late detection of SAH lies in the red cells in the Cerebrospinal Fluid (CSF). When the CT is negative and the clinical suspicion remains, the lumbar puncture (LP) continues with higher sensitivity despite is over 12 hours of the onset clinic symptoms. Conclusion:This case encourages to follow a rigorous protocol study for patients with multiple shunt dysfunction and chronic hydrocephalus. Also, this case invites to consider a hidden SAH secondary to a vascular pathology as a differential diagnosis for a multiple shunt dysfunction.
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