Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) can cause various mild to severe neurologic symptoms, leading to significant morbidity and mortality. We hereby present a fatal case of a 50-year-old male health care provider, admitted due to altered mental status due to encephalopathy, cerebral edema, and fulminant cerebral vasoconstriction caused by SARS-Cov-2. Our case highlights the importance of considering SARS-Cov-2 infection in the differential diagnosis for patients with unexplained central nervous system dysfunction and cerebral edema to prevent delayed diagnosis and render rapid treatment.
We report a case of absent pituitary infundibulum and ectopic neurohypophysis in a 4-year-old patient presenting clinically with hypopituitarism as well as heterotaxy syndrome complicated by global developmental delay and growth retardation. The clinical and laboratory workup of our patient suggested underlying hypopituitarism related to either congenital or acquired pathology, necessitating MRI to distinguish between them. We explain the various structural causes of hypopituitarism and detail how to predict the MRI findings and treatment, based on a fundamental understanding of the anatomy and pathophysiology of the hypothalamic pituitary axis and distinguishing anterior versus posterior pituitary hormone derangements. We also discuss two important theories widely acknowledged in the literature to explain congenital hypopituitarism: 1. Head trauma typically during birth resulting in a stretch injury to the infundibulum. 2. Congenital fetal maldevelopment of midline structures.
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Pfeiffer syndrome, affecting roughly 1 in 100,000 individuals is characterized by acrocephalosyndactyly – the premature closure of skull sutures (craniosynostosis). These acrocephalosyndactyly syndromes which are often sporadic de novo but also autosomal dominant in inheritance can be characterized by the fact that they often involve FGFR and TWIST genes. In the presented case, a 27-year old male level three trauma admission displayed skull abnormalities on physical examination that history taking confirmed was the result of pediatric surgically corrected Pfeiffer syndrome. Noncontrast brain CT as part of his trauma work-up revealed characteristic Pfeiffer syndrome imaging pattern of midface hypoplasia, nonvisualization of coronal and sagittal sutures, and a degree of obstructive hydrocephalus. Pfeiffer syndrome requires extensive pediatric surgery often with poor adult follow up. The case presented provides good visualization of characteristic skull abnormalities in a surgically corrected adult. By virtue of imaging an adult, this provides readers with a unique look at the long-term viability and the body's resulting physiological adaptations of the extensive mandatory pediatric surgery these patients undergo.
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.
A 58-year-old male presented to the emergency department with right scrotal pain and swelling. The patient's past medical history of epididymitis was unraveled. A multiplanar grayscale sonogram with Doppler scan of the scrotum and intra-testicular arterial pulse waveform was performed which demonstrated features of tubular ectasia of the rete testis. There was increased flow at the epididymal head which prompted the possibility of an inflammatory process consequently antibiotic therapy was administered. Tubular ectasia of the rete testis is a benign condition usually found incidentally, it has a prevalence of 1.64% in the population. This condition can be associated with a history of trauma, surgery, and inflammatory or infectious conditions. In case there is a suspicion of malignant etiology, magnetic resonance imaging (MRI) is used for better tissue differentiation. Keywords: Scrotal pain; Doppler scan; Epididymal head; Testes Case ReportA 58-year-old male presented to the emergency department with right scrotal pain and swelling. The pain was severe, gradually progressive, radiated to the groin, and worsened with touch and movement. There was associated bilateral scrotal swelling and dysuria without fever, rash, or penile discharge. Our patient reported recurrent similar but less severe symptoms, as well as a history of epididymitis two years before presentation. A multiplanar grayscale ultrasound with color Doppler of the scrotum and intra-testicular arterial pulse wave was performed, which demonstrated normal homogenous echotexture bilaterally with no evidence of intra-testicular masses. Both testes demonstrated grossly symmetric color Doppler flow with normal intra-testicular arterial waveforms. A small anechoic left epididymal head cyst without evidence of a hydrocele was visualized (Figures 1 and 2). There were right and left tubular anechoic lesions located at the mediastinum testis, more prominent on the right, consistent with tubular ectasia of the rete testes. The right epididymal head demonstrated asymmetric increased color Doppler flow compared to the left, consistent with an inflammatory or infectious process.
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