Multiple system atrophy (MSA) is a rare adult-onset neurodegenerative disease. Symptoms vary from autonomic dysfunction to Parkinsonism and cerebellar ataxia, in any combination. MSA affects many organ systems with many possible complications and makes perioperative management of a patient with this condition very challenging. Successful management of a patient with MSA posted for laparoscopic nephrectomy under general anaesthesia is reported.
Hydrogen peroxide (H2O2) irrigation is commonly utilised in neurosurgical and non-neurosurgical procedures for its bactericidal and haemostatic effects. Tension pneumocephalus and venous air embolism are potentially disastrous neurological complications mostly seen after intracranial surgery in sitting position and trauma. We present a case of oxygen embolus and tension pneumocephalus after H2O2 irrigation during craniotomy in supine position.
Over a century ago, radiologist Demetrius Chilaiditi reported a case series of three patients with the incidental radiological finding of colonic interposition between the liver and diaphragm. Thereafter called the Chilaiditi sign, this finding is a rare anomaly incidentally seen on chest or abdominal radiographs. Chilaiditi syndrome refers to the medical condition in which a Chilaiditi sign is accompanied by clinical symptoms. We report a case of Chilaiditi syndrome that was successfully diagnosed and managed.
Imbalances in the autonomic nervous system contribute to ventricular tachyarrhythmias. Sympatholysis with thoracic epidural analgesia or a stellate ganglion block attenuates myocardial excitability and the proarrhythmic effects of sympathetic hyperactivity.
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