1/12. Intraoperative haemorrhage associated with the use of extract of Saw Palmetto herb: a case report and review of literature.The significant increase in the use of alternative medicine in general and the herbal and dietary supplement in particular represents a challenge to the health care professionals. Because of their unregulated use, physicians are encountering increasing numbers of toxicities and untoward events. We report a case of severe intraoperative haemorrhage in a patient who was taking the herb Saw Palmetto. His bleeding time which was prolonged, normalized few days after he stopped the herb. This case should increase the awareness of physicians to such possible complications and encourage them to enquire thoroughly about the use of any dietary supplement in all their patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/12. Carcinomatous meningitis in a patient with metastatic breast cancer.Metastases are defined as the appearance of neoplasms in parts of the body remote from the site of the primary tumor. Metastasis can occur through one of three processes: direct seeding of body cavities or surfaces, lymphatic spread, and hematogenous spread. The importance of laboratory utilization in the diagnosis of metastasis is explored using a case study of a 39-year-old female with metastatic breast carcinoma to the brain. This case study was carried out using clinical records, laboratory results, pathology reports, and physician interviews. cerebrospinal fluid was obtained and examined in hematology, chemistry, and microbiology. Tissue from the breast was examined both before and after chemotherapy. Morphologic comparisons of both primary and metastatic tumor cells were carried out. The breast tissue showed infiltrating mammary carcinoma, ductal type, with 8/11 auxiliary lymph nodes showing metastasis. Evaluations of cerebrospinal fluid cell count results revealed the presence of malignant cells in remarkable numbers. Based on cytological and hematological results, a diagnosis of meningeal carcinomatosis was determined and treatment was started. Following the intrathecal chemotherapy, serial cerebrospinal fluid examinations showed the percentage of malignant cells decreased and no cells were detected 11 days after treatment. Metastasis, including meningeal carcinomatosis is a common occurrence with breast carcinoma. An effective chemotherapeutic treatment is evaluated for this disease when an accurate diagnosis is made. As demonstrated by this case study, proper use of the laboratory can help establish the diagnosis of metastasis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
3/12. Discovery of thoracic meningioma with cord compression on a screening "total body" computed topography scan.BACKGROUND CONTEXT: The use of "total body" screening computed tomography (CT)scans has increased dramatically, although the procedure is controversial, and its benefit to the patient is unproven. When a screening CT scan of the chest is performed, the major areas of interest are the heart and lungs. However, significant portions of the spinal column are also included in the examination. PURPOSE: To describe a case in which a screening CT scan of the chest revealed clinically important findings within the spinal column. STUDY DESIGN/SETTING: Case report. methods: Summary of clinical course and imaging studies, with literature review. RESULTS: A healthy 72-year-old woman without neurologic symptoms was self-referred for a screening "total body" CT examination. The chest portion of the study showed a calcified meningioma with cord compression at the T4 level. Within 2 months of the examination, the patient developed a progressive thoracic myelopathy and required excision of the tumor. Definitive management of the tumor was delayed because the patient was not referred for neurologic or neurosurgical consultation at the time of diagnosis. CONCLUSIONS: This case illustrates two important points. First, clinically significant pathology within the spinal column may be identified on a screening CT scan of the chest. Such lesions may have major neurologic implications for the patient. Second, because most patients undergo-ing screening radiology examinations do not have a referring physician, it is critically important for the radiologist to make prompt referral to a neurologist or neurosurgeon at the time of diagnosis.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
4/12. Cervical spine meningioma presenting as otalgia: case report.OBJECTIVE AND IMPORTANCE: Cervical spine meningiomas have not been reported to present as otalgia. It is important to include otalgia in the differential diagnosis and workup, especially when more common causes of ear pain have been excluded. CLINICAL PRESENTATION: A 66-year-old woman presented to her primary care physician with severe ear pain. She underwent routine diagnostic testing and eventually was referred to a neurologist. After conservative management failed, the patient underwent cervical spine magnetic resonance imaging, which revealed a large meningioma encompassing C2-C3. INTERVENTION: The patient underwent a cervical laminectomy with complete resection of the tumor. She experienced immediate postoperative resolution of her symptoms. CONCLUSION: This case illustrates the importance of aggressive evaluation of otalgia when routine diagnostic studies are inconclusive. Cervical meningiomas are associated with significant potential morbidity and should be excluded early in the diagnostic process.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
5/12. Acute haemorrhage into a microcystic meningioma leading to cerebral herniation.Low-grade (WHO level I) meningiomas are slow-growing, benign tumours typically presenting with unspecific symptoms (e.g. headache), seizures, cranial nerve compression and neuropsychological symptoms determined by location and size of the lesion. Haemorrhagic onset and sequelae are rare, and have been described infrequently. This is a case of a 50-year-old male presenting with signs of tentorial herniation secondary to hyperacute intratumoural haemorrhage (ITH) into a previously undiagnosed meningioma. Emergency surgical decompression and exstirpation of the lesion helped to achieve a favourable outcome. ITH has been described in all including benign intracranial neoplasms. Factors associated with a higher risk for haemorrhage in meningiomas are discussed. Though haemorrhages associated with meningiomas have been reported, ITH into low-grade meningiomas leading to herniation remains a rarity. Bearers of known lesions and their treating physicians who opt for conservative or delayed treatment should be aware of this remote complication.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
6/12. Malignant transformation of posterior fossa epidermoid cyst.The authors report the case of a 45-year-old man who presented with a short duration of a painful ophthalmoparesis. Initial magnetic resonance imaging revealed an extraaxial petroclival mass characteristic of an epidermoid cyst, with the exception of a contiguous contrast-enhancing lobule. A subtotal resection was performed with the histopathological diagnosis revealing malignant transformation of an epidermoid cyst. Despite aggressive postoperative adjuvant therapy, the patient developed leptomeningeal metastasis and died shortly thereafter. The presence of contrast enhancement at the site of an epidermoid cyst combined with an acute, progressive neurological deficit should alert the treating physician to the possibility of a malignant transformation. When transformation does occur, the clinical and radiological course is quite aggressive as compared with the indolent growth of epidermoid cysts. Treatment options include surgery with adjuvant chemotherapy or radiotherapy. We review the pertinent features of this case along with the relevant literature regarding primary intracranial squamous cell carcinomas.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
7/12. blepharospasm-oromandibular dystonia associated with a left cerebellopontine angle meningioma.blepharospasm-oromandibular dystonia is characterized by the presence of spasms of the orbicularis oculi (blepharospasm) and of the lower facial or oromandibular muscles. A patient with this syndrome is presented in which a left cerebellopontine angle meningioma appeared to act as a triggering mechanism for the development of this disorder. On the basis of this report, we recommend that physicians search for this tumor in patients with this disorder.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
8/12. lower extremity manifestations of a meningioma.physicians have long recognized that systemic diseases manifest themselves in the foot. The podiatric physician can play a crucial role in the identification of such pathologic processes. Consultation with various subspecialties, along with sensory, motor and neurologic examinations often are paramount. This article will present a case of a meningioma identified by careful podiatric evaluation and consultation with internal medicine, neurology, and neurosurgery.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
9/12. Carcinomatous meningitis from transitional cell carcinoma of the bladder: case report.In the past decade, there has been an increasing awareness of central nervous system metastases as a frequent complication of some malignancies, particularly in lung, breast and hematologic cancers. However, the central nervous system remains an uncommon location for metastases from certain primary tumors including those from the genitourinary system. We report on a patient with transitional cell carcinoma of the bladder who was treated with combination chemotherapy, and during the course of his disease developed carcinomatous meningitis. We anticipate this unusual complication of bladder transitional cell carcinoma will be seen more frequently, especially in the light of available data from effective chemotherapeutic regimens. We report this patient to alert physicians to this complication and to consider using prophylactic measures in responding patients as is the case in other malignancies.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
10/12. Spinal cord meningiomas in the elderly.The clinical features of six women with spinal cord meningioma are presented. These cases comprise the neurosurgical experience of one of the authors (B.B.) over approximately a 3-year period. Median age was 76 years with a range of 65-89 years. Previous reports of this disorder have not emphasized the occurrence of this tumour in the later decades. A notable feature was delay in diagnosis. Only one patient had a correct diagnosis of spinal cord compression prior to admission. Incorrect diagnoses included diabetes mellitus, osteoarthritis, degenerative spinal disease, gait disturbance secondary to fall and a thalamic cerebrovascular accident. gait disorders at presentation included paraparesis, wide-based gait and unclassified disability. All patients had pyramidal tract signs and five had a truncal sensory level. Plain radiographs of the spine were unhelpful and can dissuade the physician from the diagnosis. All tumours were in the thoracic region. Surgery resulted in cure in all patients and diverted one patient from planned institutional care. Spinal cord meningioma should be considered in elderly patients presenting with gait disorder.- - - - - - - - - - ranking = 0.5keywords = physician (Clic here for more details about this article) |
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