We report a case of brainstem infarction following a C5–C6 cervical transforaminal injection, a rare and serious neurological complication of this procedure. Cervical transforaminal steroid injection is a common therapy for patients with persistent cervical radiculopathy not relieved by conservative treatment, and is effective in 65–70% of cases. Unfortunately, this procedure may lead to serious complications such as neurological damage. These complications are rare but potentially fatal, as reported in our case. Complications could be due to three mechanisms: the technique itself, the cervical vascular anatomy and the properties of the product (corticoids). The neurological complications can be diagnosed through brain MRI. This case report focuses on the importance of a risk/benefit evaluation when performing this medical procedure.
LEARNING POINTS
Physicians should be better informed about severe complications following cervical transforaminal epidural steroid injections and their strict indications.
Severe adverse events are rare but they can be disastrous.
Non-particulate corticosteroid should be used.
Boerhaave syndrome or spontaneous rupture of the oesophagus is a severe condition commonly misdiagnosed or unrecognized. Prognosis is poor even if the diagnosis is made promptly. We describe a case of Boerhaave syndrome diagnosed after the development of pneumomediastinum and cardiac arrest. Unfortunately, the patient died 48 hours after admission to the Intensive Care Unit. This entity requires a multidisciplinary management approach which may include conservative, surgical or endoscopic procedures. LEARNING POINTS • Boerhaave syndrome is a diagnostic and therapeutic challenge, and rapid diagnosis and management are crucial. • A thoraco-abdominal CT scan with oesophageal opacification is the gold standard investigation. • A multidisciplinary and individualized approach is needed in the management of this condition.
We report a rare case of acute disseminated encephalomyelitis (ADEM) secondary to a primary Epstein-Barr (EBV) infection, in a 22-year-old male. Symptomatic infectious mononucleosis and ADEM are both quite uncommon conditions in this age group.
LEARNING POINTS
ADEM is a very rare CNS disorder; it is more common in childhood but can also be described in adults.
The clinical evaluation must focus on the presence of recent signs of infection or vaccination.
A normal cerebral scan does not rule out the disease and MRI must be performed to confirm the diagnoses.
Pulmonary arteriovenous malformations (PAVMs) are abnormal communications between the arteries and veins of the pulmonary vasculature leading to a right-to-left shunt. We report the case of a pregnant patient who presented with chest pain revealing a haemothorax secondary to the rupture of an arteriovenous malformation. The diagnosis was made during arteriography after simultaneous performance of an urgent caesarean section and thoracic drainage.
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