by Krishna Arpita Sahoo and Subrat Kumar Behera
Case Report
Accidental impaction of a live fish is very uncommon in Oropharynx. Sometimes the impaction of foreign body may be life threatening and requires immediate removal. We report a case where a whole fish accidentally impacted in the oropharynx of a 40-year-old male causing throat pain and dysphagia. Successful removal was done as an emergency procedure.
American Journal of Medical Case Reports. 2017, 5(4), 107-109. DOI: 10.12691/ajmcr-5-4-8
Pub. Date: May 26, 2017
10898 Views2429 Downloads
by Ganesh Kasinathan and Naganathan Pillai
Case Report
Hepatic hydrothorax is defined as significant pleural effusion greater than 500 ml in a patient with liver cirrhosis without any underlying pulmonary, cardiac and pleural disease. This case report describes a 47 year old Indian gentleman who was diagnosed as alcohol induced liver cirrhosis, Child-Turcotte-Pugh score B, with gross ascites. He presented with recurrent right sided pleural effusion. Pleural fluid analysis revealed transudative pleural effusion. A diagnosis of hepatic hydrothorax was made after excluding other causes of pleural effusion. He did not respond to medical therapy and sodium restriction. His recurrent pleural effusion was treated with tube thoracostomy and chemical talc pleurodesis. He was referred to the tertiary hepatology unit for transjugular intrahepatic portosystemic shunt (TIPSS) and liver transplantation. Hepatic hydrothorax should always be suspected in a patient who presents with liver cirrhosis with portal hypertension and transudative pleural effusion.
American Journal of Medical Case Reports. 2017, 5(4), 104-106. DOI: 10.12691/ajmcr-5-4-7
Pub. Date: May 22, 2017
12153 Views3594 Downloads
by Zahra Janamiri, Yasaman Arjmand and Pooya Torkian
Original Research
Introuction: Brain Arteriovenous malformations (AVMs) are the leading cause of intracerebral hemorrhage in the young population. We set out to determine angiographic features of AVMs in pre-operative setting as well as angiographic and neurological and clinical assessment of these AVMs after treatment with either microsurgical approach or angio-embolization. Materials and Methods: From February 2011 to January 2016, 25 patients with cerebral AVMs were admitted to Shohada Tajrish Hospital. Patients underwent angiographic evaluation for AVM grading based on Spetzler Martin grading system. Also, patient’s neurological status was recorded. Based on Spetzler Martin score and AVM size, patients underwent either microsurgical approach or angio-embolization. Post-operatively, early and long-term neurological examination was performed and obliteration rate was assessed by post-operative imaging study.Results: There were 18 male and 7 female patients with mean age of 42.2 years who presented with cerebral hemorrhage followed by isolated new-onset seizure, progressive new focal neurological deficit and severe new-onset headache in decreasing manner. Seizure was significantly higher in patients with unruptured AVMs (P value <0.01). Angiographic study based on Spetzler-Martin grading system showed that most of the patients had grade 3 (32%), followed by grade 4 (28%), grade 2 (28%), grade 5 (8%) and grade 1 (4%). Most AVMs were eloquent with superficial drainage and small sized. Based on AVM size, trend for operation type in small and medium sized AVMs was microsurgical approach followed by angio-embolization. On the other hand, most patients with large-sized AVMs underwent angio-embolization followed by microsurgical approach. Early post-operative examination revealed more new neurological deficit in angio-embolization than microsurgery treated patients (P value <0.05). Improvement in neurological status was observed in microsurgery treated cases compared to angio-embolization (P value <0.05). Long-term follow up showed similar promising results in patients treated with microsurgery which was statistically significant (P value <0.05). Post-operative imaging study demonstrates complete obliteration in 12 patients out of 15 patients (80%) who underwent microsurgical approach. Complete obliteration was observed in 4 cases out of 10 patients (40%) who were treated with angio-embolization. (P value < 0.05). Conclusion:Although results of this study showed better results with microsurgical approach, choosing best treatment option for patients suffering from symptomatic AVMs depends on imaging studies, pre-operative grading and individual-based selection.
American Journal of Medical Case Reports. 2017, 5(4), 101-103. DOI: 10.12691/ajmcr-5-4-6
Pub. Date: May 22, 2017
9075 Views3043 Downloads
by Noman Ahmed Jang Khan, Saad Ullah and Joshan Suri
Original Research
Cardioembolic ischemic infarction, the most severe subtype of ischemic strokes account for approximately 15-30 % of all ischemic strokes. The most common associated disorders include atrial fibrillation, recent myocardial infarction, dilated cardiomyopathy, mechanical prosthetic valve, and mitral rheumatic stenosis. Complex calcified atheromatosis of the aorta, defined as calcified plaques measuring > 4mm in size, ulcerated or having a mobile component are potentially emerging sources of cardioembolic infarction. We present a case of severe cardioembolism with evidence of complicated calcified aortic plaques in an otherwise healthy78 year old female.
American Journal of Medical Case Reports. 2017, 5(4), 94-100. DOI: 10.12691/ajmcr-5-4-5
Pub. Date: May 16, 2017
15862 Views2834 Downloads
by Kazuhito Hirata, Yuji Shimabukuro, Takanori Takahashi and Minoru Wake
Original Research
Esophageal hiatus hernia has been known to cause symptoms of congestive heart failure or syncope after meal due to compression of the heart, mainly the left atrium. However, compression of the left ventricle resulting in syncope has never been reported. Seventy-one year old woman developed syncope after taking a lunch. A chest roentgenogram showed possible mass lesion behind the heart. An echocardiogram revealed a mass lesion posterior to the left ventricle, resulting in “banana-shaped” deformity. A CT scan revealed a giant esophageal hiatus hernia which compressed the left ventricle. Cardiac catheterization revealed marked pressure gradient in the left ventricle suggestive of intracavitary obstruction after isoproterenol infusion. Left ventricular compression due to enlarged giant hiatus hernia after meal resulted in intracavitary obstruction of the left ventricle, causing syncopal episode in this particular patient. Dehydration and diastolic dysfunction may also have contributed.
American Journal of Medical Case Reports. 2017, 5(4), 89-93. DOI: 10.12691/ajmcr-5-4-4
Pub. Date: May 12, 2017
14563 Views3406 Downloads
by Kristi Greene Kelch, Michael Ross, Ryan Elliott and Michael Tall
Case Report
The patient was an 80 year old woman admitted to the hospital in an inpatient setting for pain control and further evaluation after a fall at home which resulted in severe low back pain and difficulty walking. Physical therapy was consulted to assess gait and transfer capabilities. At the time of initial physical therapy examination, the patient demonstrated poor bed mobility and transfer capabilities. She also demonstrated poor to fair upper or lower extremity strength with more pronounced weakness on the right. General hyperreflexia was noted (hyperactive bilateral deep tendon reflexes, positive bilateral Hoffman reflex, bilateral Babinski sign). A computed tomography scan of the head and magnetic resonance imaging of the cervical spine were ordered to assess for a cerebrovascular accident and cervical myelopathy, respectively. The cervical magnetic resonance imaging confirmed the diagnosis of cervical spondylotic myelopathy (Figure 1). The patient subsequently underwent successful surgical decompression laminoplasty from C3 to C6.
American Journal of Medical Case Reports. 2017, 5(4), 86-88. DOI: 10.12691/ajmcr-5-4-3
Pub. Date: May 04, 2017
9278 Views2308 Downloads
by Pyong Wha Choi
Case Report
Internal hernia, in which the bowel herniates through a congenital or acquired aperture in the peritoneal cavity, is one of the rarest causes of ileus. Postoperative adhesion is a common pathological phenomenon that may cause bowel obstruction by angulation or twisting. However, internal herniation through a colonic adhesion formed after gynecologic surgery is extremely rare. Here, we present a case of strangulated small bowel obstruction in a 51-year-old woman, due to internal hernia through the aperture created by adhesion of the sigmoid colon and a right salpingectomy site. The patient presented with abdominal pain and distension; she had a history of right salpingectomy for ectopic pregnancy 20 years earlier. While attempting conservative management, peritoneal irritation signs developed and emergency surgery was performed. During the operation, it was found that approximately 30 cm of the ileum had herniated through the aperture created by the adhesion. After reduction of the incarcerated small bowel, bowel resection with primary anastomosis and adhesiolysis was performed. Although preoperative diagnosis is difficult in unusual types of internal hernias, due to their rarity, a high degree of suspicion and prompt management is crucial for the prevention of morbidity and mortality.
American Journal of Medical Case Reports. 2017, 5(4), 83-85. DOI: 10.12691/ajmcr-5-4-2
Pub. Date: April 22, 2017
16492 Views2775 Downloads
by Kartik Gupta, Sravan Dubasi, Arvind Kumar and Naveet Wig
Case Report
Neuroleptic malignant syndrome (NMS) is a well-known complication of dopaminergic blockade. While there have been many case reports on Quetiapine-induced NMS, cerebrospinal fluid (CSF) abnormalities have never been documented. We report this case of bipolar affective disorder who had a previous history of Risperidone-induced parkinsonian rigidity. He presented to us 20 days after increasing lithium dose and starting Quetiapine and lamotrigine for an acute episode of mania. He had coarse tremors at rest, hyperthermia, altered sensorium and elevated creatine phosphokinase (CPK). CSF analysis showed elevated protein with no cells. A provisional diagnosis NMS was made and he was given bromocriptine. Patient’s hyperthermia resolved and CPK normalized with this treatment. He was subsequently discharged and is in follow up for his bipolar disorder.
American Journal of Medical Case Reports. 2017, 5(4), 79-82. DOI: 10.12691/ajmcr-5-4-1
Pub. Date: April 20, 2017
10817 Views2732 Downloads