Paroxysmal Sneezing at the Onset of Syncopes and Transient Ischemic Attack Revealing a Papillary Cardiac Fibroelastoma

Mathis, Stéphane; Lamy, M; Ciron, Jonathan; Iljicsov, Anna; Arjmand, Roxana; Agius, Pierre; Neau, Jean‐Philippe

doi:10.1155/2014/734849

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…As per evidence-based literature, sneezing is similar to the Valsalva maneuver, which increases the intrathoracic pressure [9]. This is associated with a simultaneous increase in ICP [9]. The same phenomenon might have contributed towards the CSF leak and TP development in our patient because the CSF leak was also noted during the surgical correction of TP.…”

Section: Discussionsupporting

confidence: 65%

“…Our patient's symptom of altered mental status (AMS) and lethargy started to happen right after a bout of sneezing, which happened the morning following a transsphenoidal surgical resection of pituitary adenoma. As per evidence-based literature, sneezing is similar to the Valsalva maneuver, which increases the intrathoracic pressure [9]. This is associated with a simultaneous increase in ICP [9].…”

Section: Discussionmentioning

confidence: 86%

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Tension Pneumocephalus: A Rare Complication of Transsphenoidal Resection of a Pituitary Macroadenoma

Iqbal

Khan

Zhi

2019

Cureus

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Tension pneumocephalus (TP) is described as the presence of a large amount of air in the cranial cavity, compressing the parenchyma and ventricles. It is a rare neurosurgical emergency and has been reported in only a handful of cases as a complication of transsphenoidal resection of a pituitary adenoma. Our reported case is an addition to the series of those cases. A 60-year-old male patient underwent transsphenoidal resection of a pituitary macroadenoma. Computed tomography (CT) of the head performed post-procedure showed post-surgical changes with no identification of any acute intracerebral processes. On postoperative Day 2, the patient had a bout of sneezing and since that time, he was noted to be more altered in terms of his mentation and lethargic with no focal neurological deficits. A repeat CT of the head showed a large amount of air in the intracranial cavity compressing the brain parenchyma with slit-like appearances of the cerebral ventricles. The patient underwent emergent bifrontal air evacuation through burr holes. A cerebrospinal fluid leak was also noted while reconstructing the skull base. A postoperative CT scan showed marked resolution of TP. The patient improved clinically, was discharged home five days later, and was monitored closely by the surgical team on an outpatient basis.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 86%

Tension Pneumocephalus: A Rare Complication of Transsphenoidal Resection of a Pituitary Macroadenoma

Iqbal

Khan

Zhi

2019

Cureus

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“…[1][2][3] The fibroelastoma consisted of a small papillary, pedunculated, and avascular tumor, covered by a single layer of endothelium containing variable amounts of elastic fibrils in the form of composed collagenous connective tissue in hyaline stroma. 4 The fibroelastoma tumors are typically located in more than 95% of cases in the left ventricle. In 45% of these cases, the tumor is positioned on the aortic valve, followed by mitral (36.4%) and pulmonary valve (8%).…”

Section: Discussionmentioning

confidence: 99%

“…Surgical treatment is indicated in cases of neurologic manifestations and in hospitalized patients suffering from syncope, transient ischemic event, or atrial fibrillation following diagnostic imaging. 4,5 Surgery is also indicated after percutaneous persistent foramen oval closure, 6 or chest pain with ST-segment elevation as myocardial infarction concerning the location of the fibroelastoma on the right or left coronary cusp. But long-term follow-up studies using echocardiography for imaging have not been done yet, and therefore the natural history or clinical manifestation of these tumors has not been presented except in one non-Hodgkin disease case (of 23 patients) within 15 years follow-up.…”

Section: Discussionmentioning

confidence: 99%

Fibroelastoma Recurrence in Left Ventricle: Rarity of Primary Cardiac Tumor

Kammerer

Besser

Al-Azani

et al. 2015

Surg J

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Cardiac papillary fibroelastoma is a primary cardiac neoplasm with an unknown prevalence but is increasingly detected by echocardiography.A 70-year-old asymptomatic man (98 kg; 178 cm) was referred in 2014 to our hospital for evaluation of two suspected cardiac tumors in the left ventricle after his first open heart surgery for fibroelastoma via conservative sternotomy in year 2005. The patient presented to our hospital with no neurologic, cardiac, or other signs or symptoms of general discomfort before he was scheduled for surgery.In 2005, after a singular transient ischemic event, a cardiac tumor was confirmed by transesophageal echocardiography in the left ventricle intertwined in the papillary muscle belly close to the mitral valve cusp. The tumor was surgically resected through a median sternotomy with the mitral valve preserved. At that time, no visible residues of the fibroelastoma had been left macroscopically, and no clinical complications in the surgical and postoperative course were then observed. During the surgery in 2005, the tumor was found on the A1 segment of the anterior leaflet and on the posterior chordae in two parts. The tumor was resected with visual confirmation. The histologic evaluation indicated a primary cardiac papillary growth with a pale basophilic myxoid stroma, with nuclear matrix eosinophilic without neoplasm potency (►Fig. 1A). Annual echocardiography and regular blood tests showed no fibroelastoma present or mitral valve dysfunction.Three years following removal of the fibroelastoma, a small formation of the tumor was detected by echocardiography. The clinical course was uneventful; therefore, no special treatment was indicated at that time. From 2013 to 2014, the tumor rapidly grew, and the patient developed benign prostate hyperplasia, which was treated with Doudart 0.4 mg (dutasteride þ tamsulosin; GlaxoSmithKline, London, United Kingdom).In 2014, the fibroelastoma recurred as detected by transesophageal echocardiography. The function of the mitral valve was normal, but the tumor tissue was detected between the papillary muscle and the chordae tendineae. Magnetic resonance imaging revealed two separate mobile and noncalcified spherical structures (1 Â 0.

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Intractable Sneezing Unfolding a Hideous Truth

Ng¹,

Husain²,

Ong³

et al. 2021

Cureus

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Intractable sneezing is a diagnosis of exclusion and is mostly psychogenic. We reported a case of an 11-year-old girl who presented with uncontrollable bouts of sneezing for three weeks, which did not respond to conventional treatment. She was eventually diagnosed to have psychogenic intractable sneezing, which was triggered by an unfortunate family circumstance. She improved with psychotherapy and was discharged well. Literature review on intractable sneezing showed that patients were predominately female teenagers and mostly recovered after psychotherapy. Multidisciplinary team effort especially with a child psychiatrist is important for the treatment and follow-up of these patients. Imaging should also be routinely performed as some had underlying organic causes that presented as intractable sneezing.

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Paroxysmal Sneezing at the Onset of Syncopes and Transient Ischemic Attack Revealing a Papillary Cardiac Fibroelastoma

Cited by 3 publications

References 19 publications

Tension Pneumocephalus: A Rare Complication of Transsphenoidal Resection of a Pituitary Macroadenoma

Tension Pneumocephalus: A Rare Complication of Transsphenoidal Resection of a Pituitary Macroadenoma

Fibroelastoma Recurrence in Left Ventricle: Rarity of Primary Cardiac Tumor

Intractable Sneezing Unfolding a Hideous Truth

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