OpenMed/multicare-articles huggingface dataset:
Extensive VZV Encephalomyelitis without Rash in an Elderly Man
Authors: Karen Lynch, Prakhar Agarwal, Anu Paranandi, Susan Hadley, Mithila Vullaganti
Journal: Case Rep Neurol Med (2014)

Introduction. Varicella zoster virus (VZV) encephalomyelitis with cranial nerve involvement is rare. Characteristically it is preceded by a rash and primarily presents in the immunocompromised. The spectrum of VZV neurologic disease is extensive and it is not uncommon to present without rash. We report the case of an elderly otherwise immunocompetent patient who presented with diverse manifestations of VZV CNS infection all occurring without rash. Case Report. A 78-year-old man presented with 1 week of progressive paraparesis and sensory loss, malaise, and fevers. MRI of the neuraxis demonstrated numerous enhancing lesions: intramedullary, leptomeningeal, pachymeningeal, and cranial nerves. Cerebrospinal fluid (CSF) showed a white blood cell count of 420/ μ L with elevated protein (385 mg/dL). CSF VZV qualitative PCR was positive and CSF VZV immunofluorescence assay detected IgM antibody, confirming the diagnosis of VZV encephalomyelitis. Clinical and radiological improvement was observed after intravenous acyclovir treatment. Conclusion. This is a rare report of an immunocompetent patient with extensive VZV encephalomyelitis. We highlight the importance of considering this diagnosis even in the absence of the characteristic rash, and the potential risk of premature discontinuation of antiviral therapy once HSV has been excluded. Prompt recognition and treatment can dramatically reduce morbidity and mortality in patients.
Romiplostim for the Emergency Management of Severe Immune Thrombocytopenia with Intracerebral Hemorrhage
Authors: Romain Gellens, Sabrina Habchi, Sebastien Freppel, David Couret, Silvia Iacobelli
Journal: Front Neurol (2018)
Keywords: hemorrhagic stroke, immune thrombocytopenia, intracerebral hemorrhage, romiplostim, thrombopoietin receptor agonist
MeSH terms: Case Reports

Currently, we lack well-established guidelines for the emergency management of severe immune thrombocytopenia (ITP) with life-threatening bleeding. We now report the management of two patients with severe ITP, complicated by substantial cerebral hemorrhage, requiring urgent surgery due to refractory intracranial hypertension. To rapidly boost platelet counts (PCs), corticosteroids, intravenous immunoglobulin, and iterative platelet transfusions were given; all were ineffectual. Romiplostim, a thrombopoietin receptor agonist, was then administered as an "on demand therapy," with the result that a rapid and sustained increase of PCs was achieved, thus allowing for postoperative hemostasis. Both patients recovered good neurological condition, suggesting the potential utility of romiplostim, in combined therapy, for the emergency management of severe ITP.
Review of Pediatric Extraosseous Chordomas with a Unique, Illustrative Case
Authors: Benjamin J Lee, Audrey Grossen, Helen Shi, Sara Abu Mehsen, Zhongxin Yu, Kar-Ming A Fung, Khairuddin Memon, Joanna E Gernsback
Journal: Pediatr Neurosurg (2023)
Keywords: extraosseous chordoma, lumbar chordoma, pediatric chordoma, spinal oncology
MeSH terms: Chordoma / diagnostic imaging, Chordoma / pathology, Chordoma / surgery, Scoliosis, Spinal Neoplasms / diagnostic imaging, Spinal Neoplasms / surgery, Review, Case Reports, Child, Female, Humans, Magnetic Resonance Imaging, Radiotherapy, Adjuvant

Introduction:
Chordoma is a rare, aggressive tumor that is believed to originate from notochord remnants. It can occur anywhere from the clivus to the sacrum and often recurs even after resection and radiotherapy. We present a unique case that initially suggested a different pathology based on imaging and presentation but was found to be a chordoma on gross and pathological analysis.
Case presentation:
An 11-year-old girl presented outpatient for scoliosis evaluation and was found to have what appeared to be a right L4 peripheral nerve sheath tumor on MRI, causing dextroconvex scoliosis. She underwent a gross total resection via a retroperitoneal approach and was found to have what appeared to be an extraosseous, extradural, extra-spinal canal lumbar chordoma. Immunohistochemical features on surgical pathology were consistent with chordoma. The patient was referred to radiation oncology for adjuvant radiotherapy and pediatric hematology/oncology for recurrence monitoring.
Discussion:
Our case is the first to present in such a manner, was shown to be external to the spinal canal, encasing the nerve root, and was the first such case in a pediatric patient. We reviewed the growing body of literature on spinal extraosseous chordomas and their characteristics within the pediatric patient population. We also reviewed chordoma pathogenesis theories as well as current and future treatment options.
Case Report: Cerebral leukodystrophy and the gonadal endocrinopathy: a rare but real association
Authors: Mohammad Humayun, Abidullah Khan
Journal: F1000Res (2018)
Keywords: vanishing white matter, leukodystrophy, neuro-ovarian failure

A 30 year old married Pakistani woman presented in January 2018 with an eight month history of progressive left sided weakness, ataxia, spasticity, underdeveloped secondary sexual characteristics and primary infertility. She was the elder sister of a 19 year old bed bound woman who was diagnosed with vanishing white matter (VWM) disease 12 months previously. The MRI scan of the brain demonstrated diffuse leukodystrophy and her hormonal assays were significant for premature ovarian insufficiency. Results from her genetic tests demonstrated a point mutation in eukaryotic initiation factor 2B (EIF2B). Thus, she was the second confirmed case of VWM from her family of 12 siblings with normal parents.
Multisystem Inflammatory Syndrome in Children (MIS-C)-A Case Series in December 2020 in Vienna, Austria
Authors: Herbert Kurz, Tomas Gombala
Journal: Front Pediatr (2021)
Keywords: covid-19, kawasaki-like, sars-cov-2, multisystem inflammatory syndrome in children, pediatric inflammatory multisystem syndrome temporally associated with sars-cov-2/covid-19 infection
MeSH terms: Case Reports

MIS-C is a novel clinical syndrome in children and adolescents, was first encountered in the spring of 2020 as a post COVID-19 multisystem inflammatory syndrome. The highest number of SARS-CoV-2 infections in Austria were registered in November 2020. In December 2020, eight patients with MIS-C were hospitalized at the pediatric department of Klinik Donaustadt, a large municipal hospital in Vienna. Six of the patients needed pediatric intensive care. As we lack any international consensus on the diagnosis and treatment of this severe complication, we used a multidisciplinary approach. The purpose was to establish an internal standard for maximizing the efficacy and safety of treatment, and standardizing the clinical management of this disease.
Muscular Activity Modulation During Post-operative Walking With Hybrid Assistive Limb (HAL) in a Patient With Thoracic Myelopathy Due to Ossification of Posterior Longitudinal Ligament: A Case Report
Authors: Hideki Kadone, Shigeki Kubota, Tetsuya Abe, Hiroshi Noguchi, Kousei Miura, Masao Koda, Yukiyo Shimizu, Yasushi Hada, Yoshiyuki Sankai, Kenji Suzuki, Masashi Yamazaki
Journal: Front Neurol (2020)
Keywords: hybrid assistive limb (hal), exoskeleton robot, gait recovery, muscle activity analysis, muscle network analysis, myelopathy, ossification of posterior longitudinal ligament (opll), synergy analysis

Disorders of the central nervous system sometimes cause severe sensory motor paralysis accompanied by gait impairment. Recently, there are several reports on the effectiveness of robot-assisted gait training for patients experiencing these issues. The purpose of this case report was to assess the neuromechanical effect of a wearable robot suit HAL (Hybrid Assistive Limb) during post-operative gait training in a patient with gait impairment due to compressive myelopathy caused by ossification of the posterior longitudinal ligament (OPLL). For this purpose, we compared lower limb muscular activities while the patient was walking with and without the robot through a course of treatment sessions by (i) gait phase-dependent muscle usage analysis, (ii) muscle synergy analysis, and (iii) muscle network analysis. The results show (i) enhanced activity of the extensor muscles for weight-bearing in the initial sessions by using HAL and reduced knee extensor and increased hip extensor activations for achieving larger steps and faster gait in the later sessions; (ii) involvement of a greater number of synergies during walking with HAL than without HAL; and (iii) modulated muscle network property during walking with HAL remaining until the next HAL session. The patient's gait was improved after completing HAL sessions, acquiring close to normal joint profile with greater range of joint movement, faster walking speed, and larger step length. We discuss that the muscular activity modulation during walking with HAL suggests altered control of the muscles by the central nervous system during post-operative walking. Activity-dependent sensorimotor augmentation by HAL is discussed in the context of recovery of gait control by the central nervous system. The relationship between the altered control and the achieved gait recovery requires further investigation.
Applicability of the model of inclusive education in early childhood education: a case study
Authors: Pille Nelis, Margus Pedaste, Carolina Šuman
Journal: Front Psychol (2023)
Keywords: case study, early childhood education, implementation, inclusive education, model

Despite the development of policies and research supporting it, inclusion remains a challenge in contemporary education. We have developed a theoretical model for implementing inclusive education, thereby supporting early childhood education quality. It is necessary to establish the applicability of this model in order to apply it to improve the practices for adopting inclusive education. We conducted a case study, which showed that all levels and key characteristics of the theoretical model were also relevant in practice. However, as a result of the case study, the features describing the key characteristics were modified compared with the initial model. Additionally, the case study revealed that some of the features did not appear in practice. Those undetected features were mostly related to understanding the concept of inclusive education and the philosophy of inclusion. There appeared a need for a clearer understanding of inclusion on both the institutional and state level. The implementation of inclusive education does not in itself always increase inclusion or reduce exclusion. Therefore, when implementing inclusive education, it is necessary to think carefully about what is being done to allow all children to be meaningfully involved in the same classroom and by their teachers.
Radiation therapy in mycosis fungoid patient
Authors: Madiha Chellakhi, Ilham Khalfaoui, Nadia Benchakroun, Zineb Bouchbika, Hassan Jouhadi, Nezha Tawfiq, Souha Sahraoui, Abdellatif Benider, Nabila Chellakhi, Asmaa Quessar
Journal: Pan Afr Med J (2019)
Keywords: mycosis fungoid, t-cell lymphoma, radiotherapy, skin
MeSH terms: Mycosis Fungoides / radiotherapy, Skin Neoplasms / radiotherapy, Case Reports, Biopsy, Humans, Middle Aged, Mycosis Fungoides / diagnosis, Skin Neoplasms / diagnosis, T-Lymphocytes / metabolism

Mycosis fungoid (MF) is a non-Hodgkin's T-cell lymphoma determined by primary cutaneous involvement. It is a slow-progressing chronic indolent disease characterized by atypical T-cells with a cerebral nucleus. Management of this disease depends on the stage and is based essentially on the systemic treatment. Radiotherapy intervenes in case of localized or extended tumor, indeed, the radiosensibility of this tumor, like any other hematological affection, makes it possible to obtain a high rate of response. Clinical case: we report the observation of a 46-year-old patient followed since 2012 for mycosis fungoid revealed by a papullo-squamous lesion located at the level of the right lumbar fossa. The diagnosis was confirmed by cutaneous biopsy, showing the presence of T lymphocytes expressing CD2, CD3, CD4, CCR4, CD45RO markers. Initial assessment included a thoraco-abdominal pelvic CT, which was normal, an accelerated sedimentation rate at the 1st hour, a high C reactive protein (CRP), the electrolytic, renal, hepatic status and the hemogram were normal. Patient received 6 courses of chemotherapy according to the COPP protocol with a decrease in the size of the lesion estimated at 40%. A norm fractionated radiation therapy was delivered at the dose of 36Gy. The evolution was marked by a complete remission, maintained after 6 months of the treatment. Mycosis fungoid is a rare disease, whose management must be discussed in a multidisciplinary team. Radiotherapy remains an interesting option for all stages, but has to be validated in largest studies.
Leaking pseudoaneurysm of lower limb saphenous vein graft: a rare complication and its successful treatment by endovascular embolization
Authors: Shaileshkumar Garge, Pooja Vyas, Krantikumar Rathod, Sunila Jaggi, Inder Talwar
Journal: BJR Case Rep (2016)
MeSH terms: Case Reports

A rare complication after lower limb revascularization using a saphenous vein bypass graft in a crush injury patient where the saphenous vein graft was the sole supplying vessel to the leg is described; a pseudoaneurysm developed in the saphenous vein graft and caused active profuse bleeding through the surgical wound. The aetiology of this condition is uncertain but it could occur owing to slippage of ligature from one of the tributaries of the saphenous vein. The diagnosis was made by digital subtraction angiography. The pseudoaneurysm was successfully obliterated by glue embolization, which stopped the bleeding immediately, with preservation of distal flow, thereby salvaging the limb.
Case Report: Successful Reperfusion of Pulmonary Thromboembolism Using tPA in a Cat
Authors: Blake Sutton, Erin Long Mays, Chris McLaughlin
Journal: Front Vet Sci (2022)
Keywords: echocardiography, feline, fibrinolytic, pulmonary thromboembolism, tpa, thrombolysis
MeSH terms: Case Reports

Pulmonary thromboembolism is a potentially life threatening condition that is uncommonly recognized in cats. Thrombolytic agents have been described as a treatment for this condition in human and canine patients, particularly in cases where hemodynamic instability is persistent despite supportive care. This report describes the clinical course, echocardiographic diagnosis, and successful thrombolysis of a cat with pulmonary thromboembolism. Despite confirmed reperfusion, the cat succumbed to thromboembolic disease highlighting the dearth of knowledge about optimal treatment of this disease process in small animals, particularly in cats.
Case Report: Cutaneous Pleomorphic Lymphangiosarcoma in a Dog Exhibiting Features of Human Composite Hemangioendothelioma
Authors: Matthew R Cook, Joshua N Lorbach, Mary E White, Geoffrey J Zann, Rachel E Cianciolo, Laura E Selmic, Vincent Wavreille, William C Kisseberth
Journal: Front Vet Sci (2021)
Keywords: canine, composite hemangioendothelioma, cytology, histopathology, lymphangiosarcoma
MeSH terms: Case Reports

Background: Angiosarcomas are a broad category of vascular origin neoplasms that are poorly characterized in veterinary species. Lymphangiosarcoma (LAS) is an uncommon type of angiosarcoma reported in humans and canines arising from lymphatic endothelium. LAS can be differentiated from other angiosarcomas in dogs based on expression of Prospero-related homeobox gene-1 (PROX-1) or lymphatic vessel endothelial receptor-1 (LYVE-1). Composite hemangioendothelioma (CHE) is a rare angiosarcoma subtype described in people and characterized by a variable biologic behavior and infrequent metastasis. This variant of angiosarcoma histologically combines features of retiform hemangioendothelioma and epithelioid hemangioendothelioma. Information regarding the cytologic and histopathologic appearance and clinical course of dogs with vascular tumors that exhibit features of CHE are unknown. Here, we report a case of pleomorphic LAS with features of CHE arising in a dog and treated with surgery and adjuvant chemotherapy. Case presentation: A 10-year-old intact male Labrador retriever presented with an approximately 6-cm-diameter cutaneous mass caudal to the left elbow that was progressively growing over 1.5 years. On physical examination, palpable extensions were identified coursing proximally over the triceps with concurrent loco-regional peripheral lymphadenopathy. Fine needle aspirates (FNA) and cytologic assessment of the cutaneous mass, left prescapular, and accessory axillary lymph nodes reported that this appeared to be a metastatic epithelial neoplasm, although a mixed carcinoma or collision tumor could not be excluded. An incisional biopsy of the mass was submitted for histopathology and was consistent with a well-differentiated angiosarcoma with features of CHE. The neoplasm expressed vimentin, CD31, von Willebrand factor (vWf), and PROX-1, supporting the diagnosis of LAS. Complete staging was performed, and no additional metastatic lesions were identified. Left forelimb amputation and lymph node removal were performed. Based on the diagnosis of metastatic LAS, doxorubicin chemotherapy was administered. 7 months post-amputation, the tumor recurred at the amputation site without evidence of metastatic disease. Conclusion: This report describes a malignant, locally aggressive lymphatic origin vascular tumor in a dog, with features consistent with descriptions of CHE in humans. Cytologic features in this case were discordant with its true mesenchymal etiology, obfuscating diagnosis. The morphologic features of the mesenchymal neoplastic population and immunohistochemistry (IHC) labeling ultimately supported a diagnosis of pleomorphic LAS with features of CHE.
Giant Cell Tumor of the Wrist After Fracture Osteosynthesis: A Case Report
Authors: Francisco Rodriguez Fontan, Diana Douleh, Andrew Federer, Bennie Lindeque
Journal: Cureus (2023)
Keywords: bone lesion, cryoablation, distal radius fracture open reduction internal fixations, giant-cell tumor of bone, tissue biopsy
MeSH terms: Case Reports

A 60-year-old female sustained a distal radius fracture and underwent open reduction internal fixation with a volar locking plate. The patient had an uneventful recovery until four months postoperatively when the patient clinically regressed, and an expansile, radiolucent metaepiphyseal lesion was found. Further workup revealed this was a giant cell tumor of bone (GCTB). Definitive management consisted of extensive curettage, cryoablation, and cementation of the lesion, and the hardware was left intact. The current case presents an uncommon presentation of GCTB. The case illuminates the importance of thorough scrutiny of postoperative radiographs when clinical improvement plateaus or regresses and the need to pursue additional workup when the clinical course is atypical. The authors query the possibility of a sub-radiological presentation of GCTB.
Trazodone Addition to Paroxetine and Mirtazapine in a Patient with Treatment-Resistant Depression: The Pros and Cons of Combining Three Antidepressants
Authors: Rui Lopes, José Carlos Alves, Raquel Garcia Rego
Journal: Case Rep Med (2016)

Dual antidepressant combination for treatment-resistant depression is a strategy well supported by literature and accepted in clinical practice. Rather, the usefulness of the combination of more than two antidepressants is controversial. This may be related to the possibility of higher side-effect burden and to doubts about its pharmacological effectiveness and therapeutic advantage compared to other standard treatment options. We report a relapse of moderate-to-severe depressive symptoms with insomnia that successfully remitted after the addition of trazodone to a dual combination of paroxetine and mirtazapine (in standard effective doses) in a patient with treatment-resistant depression. We also review the literature and discuss the utility of triple antidepressant combination in treatment-resistant depression. This clinical case highlights the utility of combining trazodone as a third antidepressant for the relapse of depressive symptoms after the failure of a dual antidepressant combination. Trazodone may be advantageous in patients presenting recurrence of moderate-to-severe depressive symptoms that include sleep problems and/or insomnia and may be particularly useful when benzodiazepines are not recommended. Although its use may be controversial and associated with higher risk of side-effects, more investigation is needed to determine the efficacy and safety for triple antidepressant combinations as reliable strategies for treatment-resistant depression in clinical practice.
Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum
Authors: Antonina Obayo, Sylvia Mbugua, Sayed K Ali
Journal: Case Rep Neurol Med (2020)
MeSH terms: Case Reports

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.
Primary squamous cell carcinoma of endometrium: case report and literature review
Authors: Fatima Zahra Farhane, Zineb Alami, Touria Bouhafa, Abderrahmane Elmazghi, Khalid Hassouni
Journal: Pan Afr Med J (2018)
Keywords: artkeywords
MeSH terms: Carcinoma, Squamous Cell / diagnosis, Endometrial Neoplasms / diagnosis, Hysteroscopy / methods, Case Reports, Review, Carcinoma, Squamous Cell / pathology, Carcinoma, Squamous Cell / therapy, Disease Progression, Endometrial Neoplasms / pathology, Endometrial Neoplasms / therapy, Female, Humans, Hysterectomy / methods, Lymph Node Excision, Lymphatic Metastasis, Middle Aged, Prognosis, Uterine Hemorrhage / etiology

In this paper, we report a case of primary squamous cell carcinoma of the endometrium (PSCCE) with a literature review. A 64-year-old woman was admitted because of postmenopausal bleeding. The gynecological exam found bleeding from the endocervix. The pelvic ultrasound objectified uterine regular contours, endometrial thickened was 10 mm, the presence of an intra cavitary lesion measuring 56/70 mm. The diagnostic hysteroscopy revealed a whitish appearance taking all the uterine cavity making evoke a tumor of the endometrium. Pelvic MRI showed a tumor limited to the uterine corpus endometrium (invasion by more than 50% of the myometrium) without invasion of the cervix. Radical hysterectomy, bilateral salpingo-oophorectomy, and lymph nodes dissection were performed. Grossly, the endometrial carcinoma was polypoid tumor occupying the entire uterine cavity. Histologically, the diagnosis of SCC was retained. No adenocarcinoma element was recognized. Neither squamous metaplasia nor dysplasia was recognized. No ectopic cervical tissue was found. The SCC was found to invade into deeper one half of the myometrium. No tumor cells were seen in other sites including the cervix, ovaries, parameters, and lymph nodes. The patients was FIGO 2009 stage IB (pT1B, N0), and was treated with adjuvant radiation. The patient had a disease progression in the pelvis 3 months after the irradiation. We reported a case of PSCCE which can help to enrich the literature for the treatment and prognosis of this disease.