The Lateral medullary syndrome is not a very common stroke. Sometimes it is under diagnosed. Mr. Ibrahim Mollah, 50 years old male person, non diabetic, non hypertensive but smoker presented with the history of sudden onset of dysphagia, dysarthria and ataxia of the gait. He is clinically and radiologically diagnosed as a case of Lateral medullary syndrome (Ischaemic stroke). With treatment this patient improved significantly. It is commonly caused by occlusion of the cranial segment of the vertebral artery or the posterior inferior cerebellar artery. The occlusion may be due to thrombosis or embolism. The emboli are coming from the heart or the great vessels. We can diagnose Lateral medullary syndrome with expert clinical eye and CT/MRI of the brain. It should be managed with appropriate treatment and physiotherapy.
Aim: To determine the validity of ultrasound in the diagnosis of malignant thyroid nodule keeping histopathology as gold standard. Methodology: This was a cross sectional study conducted in Radiology department of a Tertiary care Hospital, Islamabad for a period of one year. In this study, 55 patients who presented to indoor and outdoor department of hospital with palpable thyroid nodules underwent USG. The results of ultrasound were then compared with histopathological findings. Result: Out of 55 patients, on the basis of ultrasound, 5 male cases with thyroid nodule were malignant and 9 were benign while 8 females were malignant and 33 benign. But on histopathology report, out of 5, only 3(21%) males had malignancy while in females, 7(17%) out of 8 found malignant. 9 patients were true positive for malignancy and 4 patients were false positive, 41 patients were true negative for malignancy and one was false negative. Sensitivity was 90% while specificity was 91.1%. Positive predictive value was 69.2% and negative predictive value was 97.6%. Conclusion: Thyroid ultrasound is a valuable diagnostic tool in predicting malignancy in thyroid nodules with sensitivity of 90% and specificity of 91.1%. Keywords: Thyroid ultrasound, Echogenicity, Calcifications, Thyroid nodule
Background: Posterior fossa arteriovenous malformations (AVMs) are complex neurovascular lesions, relatively infrequent and difficultly is encountered not uncommonly during their treatment. Although they represent less than 15% of all AVMs, studies showed that they have more aggressive natural history. The authors present their initial experience with multimodality management of 20 posterior fossa AVMs, with an emphasis on endovascular treatment in Egypt. Method(s): From January 2012 to august 2015; twenty patients with posterior fossa AVMs treated with endovascular techniques, radiosurgery and/or surgery were analyzed. Result(s): Out of the twenty cases; 15 cases were treated with onyx embolisation through 27 sessions, one case with glue NBCA. Out of these cases 3 were embolised over 90%, the rest of cases were partially embolised and referred for complementary treatment with surgery or gama knife. The most frequent difficulties encountered during endovascular treatment were catheter navigation in the tortuousity of SCA (2 territories), AICA (2 territories), PICA (1 territory). Identification of onyx flow to the vein in the working angle (3 cases), extravasation of onyx (2 cases). The average occlusion rate of the AVM embolised after an average 1.8 (range 1-7) procedure per case was 52.66%. The average size of AVM embolised was 2.6 cm in maximum diameter. 4 cases (20%) complicated by cerebellar tremors and ataxia 2 of them were transitory and 2 were permanent, one case died from pulmonary embolism. Pod2 and two cases with hemihypothesia, one was permanent. Conclusion(s): Considering our early experience, onyx embolisation to posterior fossa AVMs is feasible and can lead considerable obliteration rate when the AVM has single feeder, although the consideration of deep supply to the cerebellar nuclei and brain stem perforators is of utmost importance to diminish the possible untowarded consequences.
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