Background:Painful vertebral hemangiomas are often inadequately managed medically. We evaluated the outcome of percutaneous vertebroplasty (PVP) in the treatment of painful vertebral hemangiomas refractory to medical management.Materials and Methods:14 patients (four thoracic and ten lumbar vertebra) with painful vertebral hemangiomas presenting with severe back pain for more than 6 months not responding to medical therapy were treated by vertebroplasty. Cross sectional imaging of the spine with magnetic resonance was done. Blood investigations were done to exclude coagulopathy excluded. PVP was performed under local anesthesia.Results:The pain intensity numeric rating scale (PI-NRS-11) of these patients was in the range of 7-10 (Severe Pain). After vertebroplasty 8 patients were completely free of pain (PI NRS Score 0) while 6 were significantly relieved (PI-NRS Score 1-3). No complications were observed. Two patients with associated radicular pain had good pain relief following PVP. No recurrence was found during 36 months of postoperative followup.Conclusion:PVP is a safe and effective procedure in patients with painful vertebral hemangiomas refractory to medical management.
Central nervous system (CNS) involvement in Sjogren's syndrome (SS) has a broad spectrum of presentations. We present a 33-year-old with sudden onset, rapidly progressive quadriplegia, severe dysarthria, bilateral facial palsy, bulbar palsy, and hypernatremia. The MRI of the brain revealed hyperintensity in the central pons diffusion-weighted imaging, T2-weighted imaging, and fluid-attenuated inversion recovery (FLAIR) without abnormal contrast enhancement, consistent with central pontine myelinolysis. However, there was no antecedent history of hyponatremia with rapid correction. The patient responded excellently to sodium correction and pulse methylprednisolone therapy and was erroneously diagnosed as idiopathic hypernatremic osmotic demyelination. One year later, she presented with vague constitutional symptoms, renal tubular acidosis type-1 (distal), hypokalemia with associated myopathy. Subsequent testing for anti-Sjögren's-syndrome-related antigen A (SSA)/Ro autoantibodies and a biopsy of the minor salivary gland established the diagnosis of primary Sjogren syndrome (pSS). Remission was achieved with oral prednisolone after her discharge. Neurological signs can be the initial presentation that precedes the classical systemic manifestations of multisystem autoimmune disorders like pSS. In the event of osmotic demyelination, when antecedent hyponatremia with rapid correction is not there, we suggest evaluating for possible autoimmune etiology.
Aims To evaluate the safety and effectiveness of transarterial embolization for blunt abdominal trauma in patients without the imaging signs of peritonitis or bowel injury. Materials and Methods A total of 45 patients (41 males and 4 females; mean age: 32.15) were studied, of which 48% were hemodynamically unstable. All patients underwent multidetector computed tomography prior to selective angiography and embolization. Outcomes were considered as favorable if embolization was successful in achieving hemostasis. The frequency of complications, mortality rates, and duration of hospital stay were calculated. Results Embolization was successful in achieving hemostasis in all patients. None of the patients required surgery to achieve hemostasis after embolization. The overall mortality rate was 13.3% and none related to persistent bleeding. The mean intensive care unit stay was 5.6 days and the median was 3.5 days. Only one patient required continued blood transfusion of more than 10 units after embolization. No major complications were encountered except for one patient who required hemodialysis for acute renal injury related to embolization procedure. Conclusion Transarterial embolization is very effective in treating bleeding related to blunt abdominal trauma even in hemodynamically unstable patients and is associated with minimal complications. Embolization should be considered as an integral part of resuscitative measures for bleeding related to trauma.
Most women who develop eclampsia have preceding preeclampsia (proteinuria and hypertension). This is especially true for otherwise healthy nulliparous women. However, recently, there has been a paradigm shift in this philosophy. There is mounting evidence that preeclampsia can develop even in the absence of proteinuria and hypertension and that eclampsia itself may be the initial manifestation of hypertensive disorder during pregnancy. We report a rare case of a 24-year-old primigravida at 30 weeks of gestation who presented with new-onset generalised tonic-clonic seizures without prior hypertension or proteinuria in her antenatal records. A thorough workup revealed this presentation to be the initial feature of atypical eclampsia. She was managed appropriately and discharged with an excellent outcome. This experience highlights some of the difficulties in managing a case of atypical eclampsia, namely, erratic onset and an unpredictable course, all of which interfere with timely diagnosis and treatment and contribute to maternal and fetal morbidity and mortality.
Extra cranial vertebrovertebral arteriovenous fistulas (VV AVF) are commonly associated with trauma. Their presentation may vary from palpable thrill and myelopathy or myeloradiculopathy. Sudden onset paraparesis is rare.
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