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Proptosis with Growing Skull Fracture of Orbit: A Lesser Known Entity
Sudhir Suggala,
Daljit Singh
Issue:
Volume 5, Issue 2, June 2021
Pages:
10-12
Received:
12 November 2020
Accepted:
30 November 2020
Published:
20 April 2021
Abstract: Growing skull fracture is a well known entity in neurosurgical literature. However growing skull fracture of the orbit is relatively rare and hence remains under diagnosed. Orbital fracture is more common in children. This fracture can even expand several months or years later by everting its edges. This can result in herniation of brain into orbit which can produce variable symptoms. We present a 3 year old girl with history of fall from height. Ophthalmological examination revealed left inferior displacement of the globe with proptosis and restriction of movement in left upper outer field. Sequential radiological examination revealed a growing skull fracture of orbit. Repair of the orbital roof was done with Titanium miniplates and screws and follow up examination showed complete disappearance of proptosis. The exact pathophysiology of growing fractures is still debated in the literature, but a dural laceration along a fracture line is noted in all cases, and frontobasal brain injury seems to play an important role in the pathogenesis of the fracture growth. Growing skull fracture of the orbital roof should be considered in the differential diagnosis in cases of persistent ocular symptoms. Early diagnosis and management is extremely important in the optimum management and good long-term prognosis of the patient.
Abstract: Growing skull fracture is a well known entity in neurosurgical literature. However growing skull fracture of the orbit is relatively rare and hence remains under diagnosed. Orbital fracture is more common in children. This fracture can even expand several months or years later by everting its edges. This can result in herniation of brain into orbit...
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Performance of Patients with Relapsing-Remitting Multiple Sclerosis on the Wechsler Memory Scale-Fourth Edition (WMS-IV): Preliminary Clinical Findings
Samuel Thomas Gontkovsky,
Joseph John Ryan,
Laura Glass Umfleet
Issue:
Volume 5, Issue 2, June 2021
Pages:
13-17
Received:
9 March 2021
Accepted:
29 March 2021
Published:
26 April 2021
Abstract: Historically, the Wechsler Memory Scales have been one of the most commonly used measures of memory in clinical neuropsychological evaluations. There are limited published reports, however, analyzing the performance of patients with multiple sclerosis (MS) on the Fourth Edition of the test. The aim of this investigation was to describe the utility of the Wechsler Memory Scale-Fourth Edition (WMS-IV) in detecting and characterizing the memory deficits associated with relapsing-remitting MS. Thirty-four outpatients with clinically definite relapsing-remitting MS were administered the WMS-IV and Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). Means for age, education, and duration of MS diagnosis were 43.15, 14.88, and 8.41 years, respectively. Index scores did not differ significantly across the five WMS-IV domains. Comparison of actual WMS-IV indexes with those predicted by the WAIS-IV General Ability Index revealed that in every instance predicted index means were significantly higher than actual index means. Only 6 (17.6%) of 34 patients had all five actual and predicted index scores at comparable levels; whereas, 28 (82.4%) had ≥ 1 actual indexes significantly below the predicted level. Contrary to prior research using earlier versions of these measures, more patients demonstrated relatively reduced performances on the WMS-IV Visual Working Memory Index than on the WAIS-IV Processing Speed Index. Results support the use of the WMS-IV in evaluating learning and memory in individuals with MS. Findings also challenge the notion that the information processing deficits in MS are more reflective of reduced processing speed than impaired working memory.
Abstract: Historically, the Wechsler Memory Scales have been one of the most commonly used measures of memory in clinical neuropsychological evaluations. There are limited published reports, however, analyzing the performance of patients with multiple sclerosis (MS) on the Fourth Edition of the test. The aim of this investigation was to describe the utility ...
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Ambiguous Presentations of Pyruvate Dehydrogenase Deficiency: Combined Case Studies
Mariam Hassan,
Ali Hassan,
Ahmed Shatila,
Sudhir Kumar Chirakarra
Issue:
Volume 5, Issue 2, June 2021
Pages:
18-20
Received:
10 April 2021
Accepted:
23 April 2021
Published:
30 April 2021
Abstract: Background: The pyruvate dehydrogenase (PDH) complex is essential in the glycolytic conversion of pyruvate to acetyl-CoA. This reaction helps yield adenosine triphosphate (ATP) – a source for energy. Hence, PDH deficiency will lead to metabolic dysfunction. Case: The case report at hand unearths the perplexing presentation of two genetically predisposed Emirati siblings that were found to be thiamine responsive. Both patients complained of a variety of symptoms at the same age following an episode of gastritis. They undergo extensive laboratory tests and imaging and are initially diagnosed with non-alcoholic Wernicke encephalopathy (WE). Objective: It has come to our attention that this rapidly debilitating condition demonstrates a constellation of seemingly incongruent gastrointestinal and neuropsychiatric manifestations. It is imperative that the peculiarities of this disease be recognized. Because PDH deficiency does not conform to defined diagnostic criteria outlined in evidence-based guidelines, treatment is likely to be delayed. Method: A careful retrospective scrutiny of the patients’ initial presentation and peculiar hospital course encourages identification of our limitations in providing efficacious quality care and in hopes of devising a systematic approach for future encounters. Conclusion: Any patient presenting to the emergency department with prolonged vomiting or diarrhea, for example, should be given thiamine as it is safe, inexpensive and may be lifesaving. We herein report two patients with indistinct, yet similar, signs and symptoms.
Abstract: Background: The pyruvate dehydrogenase (PDH) complex is essential in the glycolytic conversion of pyruvate to acetyl-CoA. This reaction helps yield adenosine triphosphate (ATP) – a source for energy. Hence, PDH deficiency will lead to metabolic dysfunction. Case: The case report at hand unearths the perplexing presentation of two genetically predis...
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Neuropaludism in Children: Clinical and Evolving Aspects in a Prefectoral Hospital in Guinea
Vamala Guilavogui,
Nestor Onikoyamou,
Seylan Diawara,
Kemoko Camara,
Foksouna Sakadi,
Kezely Beavogui
Issue:
Volume 5, Issue 2, June 2021
Pages:
21-24
Received:
8 March 2021
Accepted:
22 March 2021
Published:
8 May 2021
Abstract: Introduction: Cerebral malaria is one of the spontaneously fatal clinical manifestations of malaria. The aim of our study was to describe the clinical aspects and the evolving profile of cerebral malaria in children at the Coyah prefectural hospital. Material and methods: This was a prospective study of descriptive type over a period of 6 months from July 1st to December 31st, 2015. Our study was based on children admitted for severe malaria, presenting neurological signs and responding to our selection criteria. Results: 156 children were collected, with hospital frequency of 46%. The average age was 4.28 years old and the most affected age group was between 0 and 5 years (80.13%). The sex ratio=1.33; seizures and coma often preceded by fever were present in 51.92 and 23.72% respectively. Neuropaludism associated with anemia followed by cerebral malaria associated with hypoglycemia represented 52% and 26%, respectively, of the clinical phenotypes encountered in our study, while isolated cerebral malaria represented only 14%. 86.53% of patients had a favorable outcome, of which 76.27% presented no neurological abnormality on discharge and 10.26% with neurological sequelae on discharge from the hospital. 21 children or 13.47% died. Discussion: The delay in consultation in an adequate health structure linked on the one hand to the perception of modern medicine in rural areas and on the other hand to the epidemiological context of EBOLA virus hemorrhagic fever was aggravating causes of the diagnosis. Conclusion: Cerebral malaria is a major public health concern. The associated forms frequently observed lead to a fatal outcome because of the difficulties of care, especially in rural areas.
Abstract: Introduction: Cerebral malaria is one of the spontaneously fatal clinical manifestations of malaria. The aim of our study was to describe the clinical aspects and the evolving profile of cerebral malaria in children at the Coyah prefectural hospital. Material and methods: This was a prospective study of descriptive type over a period of 6 months fr...
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A Case of Refractory Absence Epilepsy Precedes Anti-MOG Associated Optic Neuritis
Katharina Blunschi,
Pallavi Avasarala,
John Schreiber,
Neha Athale,
Ilana Kahn,
Tarannum Lateef
Issue:
Volume 5, Issue 2, June 2021
Pages:
25-29
Received:
5 April 2021
Accepted:
11 May 2021
Published:
27 May 2021
Abstract: Childhood absence epilepsy (CAE) is one of the most common forms of pediatric epilepsy. While most patients become seizure free with anti-epileptic drug therapy approximately 20% do not achieve seizure remission and are defined as having refractory CAE. Epilepsy is generally thought of as a grey matter disease but has also been associated with abnormal white matter. Optic neuritis (ON), on the other hand, is typically a white matter disorder characterized by inflammation and demyelination of the myelin sheath due to autoantibodies, such as the anti-myelin oligodendrocyte glycoprotein (MOG) antibody. We present the case of an 11-year-old female with refractory CAE who developed anti-MOG antibody positive ON. CAE and ON are not commonly co-morbid and to our knowledge their co-occurrence in a patient has not been previously described. However, in this case, the CAE and ON may be related as her seizures dramatically improved after initiating immunomodulatory treatments for the ON. This may indicate a relationship between ON (potentially specific to anti-MOG positive ON) and CAE, or may suggest that there is an inflammatory component to CAE and that immunomodulatory therapies may have a role in seizure control. Thus, in cases of treatment resistant absence epilepsy, an immune work up may be helpful.
Abstract: Childhood absence epilepsy (CAE) is one of the most common forms of pediatric epilepsy. While most patients become seizure free with anti-epileptic drug therapy approximately 20% do not achieve seizure remission and are defined as having refractory CAE. Epilepsy is generally thought of as a grey matter disease but has also been associated with abno...
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Neutrophil-Lymphocyte Ratio as a Predictor of Bacterial Meningitis in Children
Ferry Yulianto,
Dewi Sutriani Mahalini,
I Gusti Ngurah Made Suwarba
Issue:
Volume 5, Issue 2, June 2021
Pages:
30-34
Received:
11 May 2021
Accepted:
26 May 2021
Published:
4 June 2021
Abstract: Diagnosis of bacterial meningitis in children is difficult. Both bacterial and aseptic meningitis have identical clinical presentation. Cerebrospinal fluid (CSF) analysis and microbacterial culture are modalities to help physician distinguishing between both of them. However, lumbar puncture procedure to gain CSF sample could not always be done due to contraindications or clinically unstable condition. Blood Neutrophil Lymphocyte Ratio (NLR) examination has a potential biomarker to differentiate causes of meningitis when CSF sample cannot be obtained, especially in the early phase of disease. This study’s objective is to determine whether the NLR value can be used as a predictor of bacterial meningitis in children. The research design was cross-sectional. Data was taken retrospectively by reviewing medical records at Sanglah Hospital, Denpasar for the period January 2017 to December 2020. Data taken were age, sex, leukocyte, neutrophils, lymphocytes count and cerebrospinal fluid culture. Analysis of NLR in conjunction with bacterial and aseptic meningitis was carried out. During the study period, a total of 100 data samples were obtained, 58 subjects were male and 42 female subjects. Non-bacterial meningitis and aseptic meningitis were found in 62 cases, while bacterial meningitis with positive CSF culture results was found in 38 cases. ROC curve analysis showed the optimal cut-off value for NLR was 5.64 which resulted in a sensitivity of 0.84 and a specificity of 0.51. The Area Under the Curve (AUC) value for the NLR was 0.67 (CI95% 0.56-0.78, p=0,003) with positive and negative predictive values being 0.41 (0.28-0.54) and 0.63 (0.56-0.7), respectively. NLR ≥5.64 can be used as one of the predictors for diagnosing bacterial meningitis in children.
Abstract: Diagnosis of bacterial meningitis in children is difficult. Both bacterial and aseptic meningitis have identical clinical presentation. Cerebrospinal fluid (CSF) analysis and microbacterial culture are modalities to help physician distinguishing between both of them. However, lumbar puncture procedure to gain CSF sample could not always be done due...
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Assessment of the Quality of Life in Patients with Epilepsy in the Populous Region of Baku
Issue:
Volume 5, Issue 2, June 2021
Pages:
35-40
Received:
13 May 2021
Accepted:
28 May 2021
Published:
7 June 2021
Abstract: An article establishes assessment of quality of life, severity of seizures and emotional condition 117 patients with epilepsy, over the age of 18 (35.13±1.19) with different form epilepsy what started from 0 to 69 years (14.22±1.26) in the Machtagа village. How showed analyzes of the survey results, the patients sub clinic 62 (52.9%) and clinic 29 (24.8%) pronounced measure depression and anxiety from scale Ziqmond and high measure severity of seizures from national hospital seizure severity scale (NHS3) (20-27 scores bу 54 (46.1%), (3-9 scores by 40 (34.2%) patients, adversely affecting to their quality of life, assessment by questionnaire «QOLIE-10» (27.1±0.3). Social status research revealed a high patients unemployment rate (82 (70.1%) p=0.911). Between 70 (59.8%) disability patients most had secondary group (р=0.938). The number of lower secondary education and uneducated patient prevailed among native (28 (36.8%)/7 (9.2%)) and nonnative (11 (26.8%)/4 (9.8%)) village population (р=0.547). In population research 65 (55.6%) patients were married, 52 (44.4%) patients were alone (р=0.386). During the study it was revealed influence of ethnocultural characteristics patients to measure quality of life. A form of expression of religious beliefs, which, in the form of a clear implementation of the established religious rules, had a positive effect on the quality of life of patients from the hunhar and kechan mehelle, and mysticism in relation to religion, a form of upbringing in a family without encouraging intellectual development, and even prohibitions on obtaining an education, contributed to the formation passive personality with disabilities among patients from seidler mehelle, which affected their QOL negatively.
Abstract: An article establishes assessment of quality of life, severity of seizures and emotional condition 117 patients with epilepsy, over the age of 18 (35.13±1.19) with different form epilepsy what started from 0 to 69 years (14.22±1.26) in the Machtagа village. How showed analyzes of the survey results, the patients sub clinic 62 (52.9%) and clinic 29 ...
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