thanks for sharing such a good case report,
but is there any way we can prevent calciphylaxis ? or serial checking the
calcium levels could do the job?
thanks.
Is it not a possibility that this patient coincidentally had an
internal laryngocoele and otalgia of a different cause?
You mentioned that she had dried blood in her external auditory
canal/tympanic membrane, where you able to find a reason for this? Could
this or the underlying reason for this have contributed to her pain?
Just because her otalgia resolved over the same 3 month time period,
that her...
Is it not a possibility that this patient coincidentally had an
internal laryngocoele and otalgia of a different cause?
You mentioned that she had dried blood in her external auditory
canal/tympanic membrane, where you able to find a reason for this? Could
this or the underlying reason for this have contributed to her pain?
Just because her otalgia resolved over the same 3 month time period,
that her laryngocoele was surgically treated, does not necessarily mean
that this was the cause of her pain.
The laryngocoele was probably an incidental finding on the MRI as she
was otherwise asymptomatic.
Maharshak I, Bourla D, Grinbaum A, Weinberger D, Axer-Siegel R.
Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah
Tiqva 49100, Israel. imaharshak@gmail.com
Sethiya et al presented a constellation of solid neurological signs
in a middle-aged male.
1. The author did not add a differential diagnosis list for this
constellation?
2. The MRI images do not "teach" anything. The right image is an
axial T2 FLAIR one while the left image is a sagittal T2-weighted one.
Hyper- or hypo-intense signals in the mesencephalon on these films; the
p...
Sethiya et al presented a constellation of solid neurological signs
in a middle-aged male.
1. The author did not add a differential diagnosis list for this
constellation?
2. The MRI images do not "teach" anything. The right image is an
axial T2 FLAIR one while the left image is a sagittal T2-weighted one.
Hyper- or hypo-intense signals in the mesencephalon on these films; the
potential cause(s) of this imaging abnormality? In addtion, there is a
striking C-shaped hyper-intense signal around the Sylvian aqueduct on the
FLAIR film. What are these, the readership might ask?
3. The autopsy addressed the lung as the cause of death; the
patient's brain undiagnosed disaster was ignored?
4. The case was published sometime ago in the website and the legend
for figure one was "corrected." I think the journal should mention that
there is an "erratum;" I have "2 PDFs" of his article!
So, after all, it's all about "Images In." As a neurologist who is
interested in teaching under- and postgraduates, I may ask: What have we
learned from this case's "images?"
Thanks!
Conflict of Interest:
None declared
Editor's Note - there was indeed a previous version of this article that contained significant errors so a correct version was published. We agree this should have been more transparent to the readers and a notice will be published shortly notifying readers to the previous publication
Yes, brain regression is known in certain infiltrative and
degenerative conditions, but, the problem as raised by Prof Agrawal S and
Nathani S here is, that Ursula von Schenk et al from Germany, when first
reported brain regression due to B12 deficiency followed by recovery
shortly on therapy, it contradicted the very concept of atrophy and
regression. And to the non radio/imaging experts it appeared simply that
two ima...
Yes, brain regression is known in certain infiltrative and
degenerative conditions, but, the problem as raised by Prof Agrawal S and
Nathani S here is, that Ursula von Schenk et al from Germany, when first
reported brain regression due to B12 deficiency followed by recovery
shortly on therapy, it contradicted the very concept of atrophy and
regression. And to the non radio/imaging experts it appeared simply that
two images at different planes were used to claim high signal image
pathology in their figure 1. Zekai Avci et al from Turkey 2003 presented
good images for the same claim, yet, to the non image experts there were
no visible fronto-parietal hyper intensive lesions appreciable in cortex.
It looked as if gray matter image was seen in the fist figure and white
with gray in second with no appreciable intensity differences. These
researches of course in the domain of Radio and Imaging, experts could be better interpretors. In the present case, since Agarwal and
Naithani pointed out, it appears that their opinion is scientifically
factual.
Schistosoma mansoni parasitizes medium sized mesenteric veins and
arteries and its ovum is armed with a lateral spine, so intestinal mucosa
suffers on account of ova from mesenteric arteries reaching the mucosal
capillaries. Spine helps rupture of capillary facilitating release of the
ovum and blood into the lumen of the intestine. So diarrhoea in case of S
mansoni infestation is often blood mixed, particularly in the ph...
Schistosoma mansoni parasitizes medium sized mesenteric veins and
arteries and its ovum is armed with a lateral spine, so intestinal mucosa
suffers on account of ova from mesenteric arteries reaching the mucosal
capillaries. Spine helps rupture of capillary facilitating release of the
ovum and blood into the lumen of the intestine. So diarrhoea in case of S
mansoni infestation is often blood mixed, particularly in the phase when
ova are detectable in the stool. Authors while correctly pointed out
currently low incidence of this disease in European countries, image of
the ovum of S mansoni under microscope in this case should have been shown
for sake of the young generation of diagnosticians in the region.
On 24 April 2010 at about 8 pm I was taken to Accident and Emergency
Department of Prince of Wales hospital (Sydney) by my daughter because I
could not recall what had happened during the afternoon. I could remember
events up till meeting friends for lunch at 12 noon, then events from 5 pm. My
daughter stated that I "was not myself" and repeated same
questions/phrases since I returned home at 4:30 pm,
On 24 April 2010 at about 8 pm I was taken to Accident and Emergency
Department of Prince of Wales hospital (Sydney) by my daughter because I
could not recall what had happened during the afternoon. I could remember
events up till meeting friends for lunch at 12 noon, then events from 5 pm. My
daughter stated that I "was not myself" and repeated same
questions/phrases since I returned home at 4:30 pm,
I do not have any history of migraine headache, epilepsy nor head
injury. The following investigations were taken during my 11 hours stay at
the hospital: ECG (sinus rhythm); CT Brain (nil acute bleed or mass); FBC (normal).
I started to fully orientate about 1 am and was discharged at 8:30 am the
following morning. My diagnosis Transient Global Amnesia.
I found this article about TGA associated with statin; I wonder if my
episode was caused by statin. I was put on 5 mg of rosuvastatin 10 days
prior to my amnesia.
B12 deficiency has always been a puzzle in pediatric population.
Theoretically B12 deficiency is claimed to not occur in children due to
reduced need of children and it takes years to develop cobalamine
deficiency in children from malnutrition.
Although most B12 deficient infants are failing to thrive, the aetiology
for B12 deficiency is probably intrauterine and may be maternal B12
deficiency in addition, which explain...
B12 deficiency has always been a puzzle in pediatric population.
Theoretically B12 deficiency is claimed to not occur in children due to
reduced need of children and it takes years to develop cobalamine
deficiency in children from malnutrition.
Although most B12 deficient infants are failing to thrive, the aetiology
for B12 deficiency is probably intrauterine and may be maternal B12
deficiency in addition, which explains age of onset of B12 deficieny
symptoms in children from age 8 month onwards.
In India, we come across various manifestations of B12 deficiency apart
from anemia. Rather anemia is the least common manifestation of B12
deficiency in children. This is due to the fact that dietary and breast
milk folate can partially reverse the hematological symptoms. Also
idiopathic bone marrow suppression with thrombocytopenia or leucopenia may
be associated with macrocytosis with anemia.
So most infants purely manifest as neurological syndromes.
Various mechanisms of actions of B12 or cyanocobalamin in DNA synthesis
and myelin formation nay explain various manifestations in children.
Sensory symptoms of peripheral neuropathy being difficult to test in
infants, they manifest as lethargy, apathy and depressed reflexes which
may be likely to be interpreted as neuroregression.
Central nervous symptoms have been documented in literature from lethargy
or convulsion to coma and mental retardation. However, tremors are the
most often seen neurological symptoms in infants as described in infantile
tremor syndrome.
Reversible hyperpigmentation of skin especially over digits and toes has
been often associated with B12 deficiency. It may be a common accompanying
feature in infantile tremor syndrome.
It is interesting to label these neurological features as neurorgression
solely due to neuroimaging evidence.
RDD is a rare histiocytic proliferative disorder of unknown etiology,
commonly presents with painless massive lymphadenopathy and multiple extra
nodal manifestations. Here we present a 13-yr old girl who presented with
irregular low-grade fever with malaise, anorexia and nausea for last six
months followed by five painless soft tissue swellings over the scalp,
4X3cm in diameter without bony involvement and multiple bilater...
RDD is a rare histiocytic proliferative disorder of unknown etiology,
commonly presents with painless massive lymphadenopathy and multiple extra
nodal manifestations. Here we present a 13-yr old girl who presented with
irregular low-grade fever with malaise, anorexia and nausea for last six
months followed by five painless soft tissue swellings over the scalp,
4X3cm in diameter without bony involvement and multiple bilateral painless
cervical & submandibular lymph nodes, 2-3 cm in diameter and
progressive eyelid swelling and protrusion of eyeballs since last 20 days.
Isthmus and left lobe of thyroid gland were moderately enlarged and non-
tender. She also had mediastinal lymphadenopathy compressing the left main
broncus and have dry irritating cough and progressive exertional shortness
of breath since last 15 days with severe dyspnoea and stridor on the day
of admission. There were no history of haemoptysis, weight loss,
arthralgia, rashes, photophobia, bleeding manifestations, high-risk sexual
behavior, or contact with animals. Her thyroid function was normal and anti-TPO antibody was negative.
Fine needle aspiration was done from thyroid gland, scalp mass and
cervical lymph node and was sufficient to diagnose to be a case of Rosai
Dorfman Disease.
Thyroid involvement in RDD is a rare entity and commonly occurs in
older women (mean age 56.3 years) whereas nodal RDD predominantly
presents in early age.[1] Our patient presented at 13 years of age without
any thyroid dysfunction and recovered fully with short course of
prednisolone therapy.
Reference
1. Lee FY, Jan YJ, Chou G, Wang J, Wang CC. Thyroid involvement in
Rosai-Dorfman disease. Thyroid 2007;17:471-6.
The evidence presented by authors (Brian Hurwitz,and Joshua
Richardson) is informative. However, it may be added further that Long-haul
air travel has been well known to give rise to high altitude motion
sickness, cerebellar edema and speech and orientation problems[1]. The
young 14-year-old fellow and his father, since, showed no investigative
findings confirmatory of viral disease. So it could be that they were more
sus...
The evidence presented by authors (Brian Hurwitz,and Joshua
Richardson) is informative. However, it may be added further that Long-haul
air travel has been well known to give rise to high altitude motion
sickness, cerebellar edema and speech and orientation problems[1]. The
young 14-year-old fellow and his father, since, showed no investigative
findings confirmatory of viral disease. So it could be that they were more
susceptible to air travel disease than the fellow passengers, hence,
required a careful MRI brain to exclude anything which could likely
facilitate edema or hypoxia of the brain more than usual.
References:
1. Cesarone MR et al. Prevention of Edema in Long Flights with Pycnogenol. Clin.Appl.Thromb.Hemost. 2005;11(3):289-294.
Dear author ,
thanks for sharing such a good case report, but is there any way we can prevent calciphylaxis ? or serial checking the calcium levels could do the job? thanks.
Conflict of Interest:
None declared
Is it not a possibility that this patient coincidentally had an internal laryngocoele and otalgia of a different cause?
You mentioned that she had dried blood in her external auditory canal/tympanic membrane, where you able to find a reason for this? Could this or the underlying reason for this have contributed to her pain?
Just because her otalgia resolved over the same 3 month time period, that her...
Dear Editor,
I have read the well written case report "Missile launch pad: an unusual consequence of airbag deployment" by Davies et al.
I believe that my article published in Cornea in 2005 (see details below), should be part of the reference list for this case report.
Best wishes, Idit Maharshak
Cornea. 2005 Jan;24(1):110-1. Airbag-induced bilateral corneal graft dehiscence.
...Dear Editor,
Sethiya et al presented a constellation of solid neurological signs in a middle-aged male.
1. The author did not add a differential diagnosis list for this constellation?
2. The MRI images do not "teach" anything. The right image is an axial T2 FLAIR one while the left image is a sagittal T2-weighted one. Hyper- or hypo-intense signals in the mesencephalon on these films; the p...
Yes, brain regression is known in certain infiltrative and degenerative conditions, but, the problem as raised by Prof Agrawal S and Nathani S here is, that Ursula von Schenk et al from Germany, when first reported brain regression due to B12 deficiency followed by recovery shortly on therapy, it contradicted the very concept of atrophy and regression. And to the non radio/imaging experts it appeared simply that two ima...
Schistosoma mansoni parasitizes medium sized mesenteric veins and arteries and its ovum is armed with a lateral spine, so intestinal mucosa suffers on account of ova from mesenteric arteries reaching the mucosal capillaries. Spine helps rupture of capillary facilitating release of the ovum and blood into the lumen of the intestine. So diarrhoea in case of S mansoni infestation is often blood mixed, particularly in the ph...
On 24 April 2010 at about 8 pm I was taken to Accident and Emergency Department of Prince of Wales hospital (Sydney) by my daughter because I could not recall what had happened during the afternoon. I could remember events up till meeting friends for lunch at 12 noon, then events from 5 pm. My daughter stated that I "was not myself" and repeated same questions/phrases since I returned home at 4:30 pm,
I do not h...
B12 deficiency has always been a puzzle in pediatric population. Theoretically B12 deficiency is claimed to not occur in children due to reduced need of children and it takes years to develop cobalamine deficiency in children from malnutrition. Although most B12 deficient infants are failing to thrive, the aetiology for B12 deficiency is probably intrauterine and may be maternal B12 deficiency in addition, which explain...
RDD is a rare histiocytic proliferative disorder of unknown etiology, commonly presents with painless massive lymphadenopathy and multiple extra nodal manifestations. Here we present a 13-yr old girl who presented with irregular low-grade fever with malaise, anorexia and nausea for last six months followed by five painless soft tissue swellings over the scalp, 4X3cm in diameter without bony involvement and multiple bilater...
The evidence presented by authors (Brian Hurwitz,and Joshua Richardson) is informative. However, it may be added further that Long-haul air travel has been well known to give rise to high altitude motion sickness, cerebellar edema and speech and orientation problems[1]. The young 14-year-old fellow and his father, since, showed no investigative findings confirmatory of viral disease. So it could be that they were more sus...
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