Журнал клинических случаев

Nasopharyngeal carcinoma is a relatively uncommon malignancy in South India. Exact incidence in Indian population is not known. It usually presents with either epistaxis, mass in the neck, or cranial nerve(s) involvement. This is an interesting case because isolated sixth nerve involvement on presentation is rare.

Tuberculous meningitis (TB meningitis) is a subacute meningitis known for its various form of initial manifestations, which often make early diagnosis difficult. Psychosis is a rare manifestation of this disease. We reported a case of 19-year-old woman who presented with worsening psychotic disorder of one year duration. She presented initially with social isolation with subsequent mutism and stupor. Initial brain imaging & Electroencephalography (EEG) was unremarkable. Cerebrospinal fluid (CSF) investigations revealed positive cerebrospinal fluid Mycobacterium tuberculosis polymerase chain reaction (MTB PCR). She was treated with empirical antituberculosis drugs and steroids. Subsequently her psychotic symptoms resolved. As a conclusions, the psychotic disorder was most likely caused by TB meningitis. TB meningitis should be considered in patients with no background history of psychiatric illness presenting with psychotic disorder especially in countries with high TB burden.

Inguinoscrotal hernias that contain bladder diverticulae are a rare occurrence. We report the case of a 85 yearold man with intense radioactivity overlying the left pubic tubercle on [Tc99m]-methylene-diphosponate (MDP) bone scan. SPECT/CT imaging established the diagnosis of excreted urinary radioactivity within a large herniated bladder diverticulum. SPECT/CT is a useful technique for evaluation of non-osseous uptake on [Tc99m]-MDP bone scintigraphy

Purpose: Primary intraocular lymphoma is a primary central nervous system lymphoma in which lymphoma cells invade the retina, vitreous, or optic nerve head without concomitant central nervous system involvement. The aim of this presentation is to report a case of primary intraocular non-Hodgkin lymphoma. Methods: The authors present a case report of a 77 years-old female with painless decreased in visual acuity and floaters. Ophthalmic examination, Static computerized Perimetry, Spectral-Domain Optical Coherence Tomography, angiography, laboratory study, lumbar puncture, computed tomography scan and magnetic resonance imaging were performed. Results: On examination, best corrected visual acuity was 20/25 in the right eye and 30/60 in the left eye. Slip lamp examination revealed anterior chamber reaction and fundoscopy showed vitritis, optic disc edema, macular edema and vasculitis in left eye. After three months of follow-up, the patient’s best corrected visual acuity decreased to 20/60 in right eye and light perception in left eye. Fundoscopy revealed vitritis, optic disc edema, macular edema and vasculitis in both eyes. A granular pattern, leakage from retinal vessels and optic disc were observed in fluorescein angiography. Infectious and inflammatory etiologies were excluded. Pars plana vitrectomy and retinal biopsy were performed in left eye. Cytology evaluation revealed atypical lymphoid cells with large nuclei, prominent nucleoli and basophilic cytoplasm, and confirmed the diagnosis of intraocular lymphoma. Conclusion: Intraocular Lymphomas are rare malignancies that display a wide array of clinical manifestation, therefore diagnosis can be challenging. It requires a high degree of clinical suspicion and differential diagnosis includes infectious and non-infectious etiologies.

Intestinal tuberculosis, though uncommon in the US and other western countries is fairly common in other part of the world. In 2013 for instance, the prevalence rate in the US was approximately 6 cases per 1,000,000 persons while in Africa, it was approximately 6 cases per 10,000 persons. It is a condition where Mycobacterium tuberculosis or Mycobacterium bovis cause infection in the intestines creating patches and lesions in the intestinal mucosa.

Background: Botulinum toxin type A (BoNT-A) has been used in treating dysphagia due to spasticity of upper oesophageal sphincter (UES). However, the doses commonly injected could result ineffective. A case of dysphagia treated successfully by high dosage of BoNT-A is described. Case report: A 50 year-old male subject with tetraparesis and dysphagia due to severe spasticity of UES following encephalitis. No bolus transit was observed to videofluoroscopy (VS). Because of severe UES spasticity, it was not possible to perform oesophageal manometry. Growing BoNT-A dosage of 10 U (Botox) and 100 U (Xeomin) injected into cricopharingeal muscle (CM) had no benefit. Since negative effect of previous doses, BoNT-A (Xeomin) high dosage of 200 U was injected into CM. After neurotoxin injections,VS showed significant dysphagia improvement lasting eight months. Transient paresis of the right vocal cord occurred. A second BoNT-A injection session with same dosage and modalities was performed efficaciously. Conclusion: High dose of 200 U of BoNT-A (Xeomin) was efficacious and safe in treating refractory dysphagia due to severe spasticity of UES. High dosage of neurotoxin should be considered when common doses were ineffective

Unexpected radioiodine distributions may be encountered on post-therapy I-131 thyroid cancer scans due to a range of benign physiological processes, causing diagnostic dilemma and potentially mimicking metastatic disease. We present two cases of intense focal uptake related to concentration of radioiodine activity on wrist-watches by differing mechanisms, which should be confirmed by clinical history and not be mistaken for metastatic disease.

The technique perone pro tibia graft for the leg reconstruction was described for the first time at the end of the nineteen century. With the advancement of new techniques, for example, Masquelet induced membrane and distraction osteogenesis, the aforementioned procedure has been almost forgotten. There are several complications associated with the procedure including the fracture of the perone, nonunion and shortening of the lower limb.

Primary intraosseous cavernous hemangioma is a rare benign skeletal tumor, which occurs at all ages, but is more common in the 4th decade of life. Bone hemangioma is a vascular hemartoma of bone structures and primary lesion accounts for less than 1% of all bone tumors with a male to female ratio of 1/1.5. We present a rare case of a 55 year old female patient, presenting with complaints of knee pain for 2 years with no significant traumatic history. Radiological investigation was done and patient then underwent tumor excision with curettage and bone cementing of the right proximal tibia. Histopathological sample was later diagnosed as cavernous hemangioma.

Stiff person syndrome is a rare disorder affecting the musculoskeletal system due to an underlying autoimmune process. Our case describes a 36 year old female who presented with painful, distressing, intermittent muscular rigidity and a possible associated seizure disorder. The key highlight of our case is the misdiagnosis of her disease in the early stage and the successful management of stiff person syndrome with intrathecal baclofen.

Ependymomas constitute 4-6% of primary central nervous system tumors. Spinal ependymomas are most frequently found in intramedullary region but fewcases of intradural extramedullary ependymoma have also been reported. We report a 24-year-old male patient with a suspected case of intradural extramedullary ependymoma. Magnetic resonance images of the lumbar spine depicted an intradural mass from L1-L4 level. The spinal lesion was isointense on T1-weighted images and hyperintense on T2-weighted images, relative to the spinal cord. Laminectomy L1-L4 with gross-total excision was performed. Histopathological examination was inconclusive but suggested the possibility of ependymoma. Neurological recovery was initially observed but after few months symptoms worsened.

Henoch-Schönlein purpura (HSP), also known as anaphylactoid purpura [1], is the most common form of systemic vasculitis in children [2,3]. Most cases occur between the ages of 4 and 7 years [1]. HSP has several clinical and laboratory manifestations. Palpable purpura can be identified in practically all patients, most of whom develop polyarthralgia with a lack of frank arthritis. Gastrointestinal manifestations occur in 70% of children and mainly consist of colicky abdominal pain, primarily due to intestinal submucosal bleeding and edema that can lead to intussusception.

Traumatic injuries can compromise the vascular supply to tissues. After tissue repair, they are at risk of venous congestion due to the increased duration for venous neovascularisation compared to arterial. If not treated acutely, this can result in tissue necrosis (approximately three hours compared to arterial insufficiency, which takes thirteen hours [1]. There are many ways to treat venous congestion (e.g. anticoagulants, aspiration, decompression and etc) but an effective welldocumented method is by using medicinal leeches [2].

There have been many claims of remissions in cancer patients taking a variety of non-conventional therapies but few stand up to objective clinical and pathological scrutiny. These apparent miracle cancer cures can often be dismissed because histological proof of malignancy was missing in the first place, or the patient forgot to mention that he or she was taking conventional therapy as well.

All kinds of foreign bodies have been described in most part of the body. Head injury after explosion of bomb can result in devastating functional and neurological consequences for patients. There is no consensus in the terms of removing or retaining longstanding foreign bodies such as pellets. We report a case of 55-year old male who suffered from blast injury 35-year ago. Although most of the pellets in the head and neck were still present after secondary blast injury, but there were no symptoms such as lead poisoning, foreign body reaction, recurrent infections to date except feeling of nasal blockade, cold and headache during the winter season.