Extensive Lesions Research Articles

Orbital Apex Syndrome Caused by Invasive Fungal Sinusitis due to Candida glabrata: A Case Report

Purpose: To report a case of orbital apex syndrome resulting from invasive fungal sinusitis attributed to the unusual <i>Candida glabrata</i> species.Case summary: A 76-year-old patient presented with persistent left-sided orbital pain, headaches, and blurred vision for 3 weeks. The patient had a history of uncontrolled diabetes, chronic kidney failure, and angina, and was treated for a COVID-19 infection 1 month prior to admission. Contrast-enhanced computed tomography scans revealed extensive bilateral sinusitis affecting the left optic nerve. The patient underwent endoscopic sinus surgery, which included nasal cavity biopsy, conducted by an otorhinolaryngologist. Histopathological analysis using Gömöri methenamine silver stains identified <i>Candida</i>. Cultures from sinus specimens later grew <i>Candida glabrata</i>. Treatment involved daily IV amphotericin B followed by oral itraconazole. After 6 months, the patient fully recovered from fungal sinusitis but continued to experience negative light perception in the left eye and progressed to complete ophthalmoplegia, consistent with orbital apex syndrome.Conclusions: Reports of invasive fungal sinusitis caused by <i>Candida</i> infections are rare globally. This report marks the first occurrence in this country. Effective management requires careful assessment and appropriate treatment tailored to the specific species, especially considering the risk of orbital extension of the inflammatory lesion.

Calvarial Tuberculosis: Shifting Paradigm from Surgical to Conservative Approach

Abstract Background Tuberculosis (TB) is an endemic disease in developing countries like India. However, incidence of calvarial TB is very low and it presents in varied forms posing a diagnostic dilemma and delay in management. Objectives This article reports a case series of 15 patients with varied presentations of calvarial TB from a tertiary care superspeciality center of Haryana state in India. Material and Methods Study is a retrospective analysis of 15 patients with calvarial TB treated between 2018 and 2021 in a tertiary care hospital. Clinical features, radiological findings, surgical and medical management, and outcomes were reviewed. Results Of the 15 patients, 9 were males and age ranged between 12 and 45 years. Mean duration of symptoms was 2.9 months (range 1–5 months). The most common presenting symptoms were scalp swelling, discharging sinus, and pain. Four patients were treatment defaulters of pulmonary TB and two patients were found human immunodeficiency virus positive. Brain imaging showed peripherally enhancing extradural collection with bone erosions in most cases. Eleven patients were managed conservatively with fine-needle aspiration cytology (FNAC) or local debridement/sinus excision. Four patients were managed surgically with drainage of collection, excision of necrotic bone, followed by antitubercular therapy. One patient needed cerebrospinal fluid diversion for associated hydrocephalous with tubercular meningitis which could not recover and succumbed. Conclusion Calvarial TB is a rare occurrence of common prevalent diseases. Conservative management with FNAC and sinus excision followed by antitubercular treatment are the mainstay of treatment. Surgery should be reserved for extensive lesion or lesion with mass effect.

Non-surgical endodontic treatment of a type III dens invaginatus with large perirradicular radiolucency using bioceramic materials: Case report

Dens invaginatus (DI), also known as dens in dente, is an uncommon dental anomaly in humans, characterized by irregular morphological development during odontogenesis, which can manifest in various coronal and radicular anatomies. Endodontic treatment of teeth with this variation demands anatomical knowledge, detailed planning, and the use of specialized techniques and materials. The objective of this research is to detail, through a case report, the non-surgical endodontic treatment of type III dens invaginatus in the upper lateral incisor with extensive periapical lesion, using bioceramic materials. An 18-year-old female patient was referred to the referral center by an orthodontist after radiographic examination revealed an extensive periapical lesion on tooth 12. Consequently, cone beam computed tomography was requested to assess the lesion and internal/external anatomy. The endodontic treatment was performed entirely under operative microscopy, utilizing mechanized instrumentation and thermoplasticized obturation. Disinfection was enhanced through activated irrigation technique and intracanal placement of bioceramic medication, with periapical repair achieved using bioceramic sealer cement. Long-term follow-up demonstrated that conservative endodontic treatment, employing modern techniques alongside bioceramic materials, proved effective in resolving complex cases.

Clinical features of unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy and seizure outcome with different treatment options.

To provide evidence for choosing surgical or nonsurgical treatment for epilepsy in patients with unilateral multilobar and hemispheric polymicrogyria (PMG). We searched published studies until September 2022 related to unilateral multilobar and hemispheric PMG and included patients who were followed up at the Pediatric Epilepsy Centre of Peking University First Hospital in the past 10 years. We summarized the clinical characteristics and compared the long-term outcomes after surgical or nonsurgical (anti-seizure medications, ASMs) treatment. A total of 70 patients (49 surgical, 21 non-surgical) with unilateral multilobar and hemispheric PMG were included. The median age at epilepsy onset was 2.5 years (1.0-4.1). The most common seizure types were focal and atypical absence seizures. In the whole cohort, 87.3% had hemiparesis and 67.1% had electrical status epilepticus during slow sleep (ESES). There were significant differences in age at epilepsy onset, extent of lesion, and EEG interictal discharges between the two groups. At the last follow-up (median 14.1 years), the rates of seizure-freedom (81.6% vs. 57.1%, p = 0.032) and ASM discontinuation (44.4% vs. 6.3%, p = 0.006) were higher in the surgical group than in the nonsurgical group. Patients in the surgical group had a higher rate of seizure-freedom with complete resection/disconnection than with subtotal resection (87.5% vs. 55.6%, p = 0.078), but with no statistically significant difference. In the nonsurgical group, more extensive lesions were associated with worse seizure outcomes. Cognition improved postoperatively in 90% of surgical patients. In patients with unilateral multilobar and hemispheric PMG, the age of seizure onset, the extent of the lesion and EEG features can help determine whether surgery should be performed early. Additionally, surgery could be more favorable for achieving seizure freedom and cognitive improvement sooner. We aim to summarize clinical characteristics and compare the long-term outcomes after surgical and nonsurgical (ASM) treatment to provide a basis for treatment decisions for patients with unilateral multilobar and hemispheric polymicrogyria (PMG)-related epilepsy. We found that patients with unilateral hemispheric and multilobar PMG had significantly higher rates of seizure freedom and ASM discontinuation with surgical treatment than with nonsurgical treatment. In the surgical group, seizure outcomes were better in patients treated with complete resection/disconnection than in those treated with subtotal resection, but the difference was not statistically significant.

Lymphomatosis cerebri caused by adult T cell leukemia/lymphoma: a differential diagnosis for depression: a case report

BackgroundPrimary central nervous system lymphoma is rare, and primary central nervous system T cell lymphoma is relatively uncommon, contributing to < 5% of all cases. Lymphomatosis cerebri, a rare subtype of primary central nervous system lymphoma, is characterized by extensive white-matter lesions on magnetic resonance imaging and nonspecific symptoms, such as cognitive decline and depression. Reports of lymphomatosis cerebri in adult T cell leukemia/lymphoma are limited.Case presentationA 49-year-old Japanese man gradually developed insomnia, anorexia, and weight loss over a 2-month period following work-related promotion. Initially diagnosed with depression, his condition rapidly deteriorated with cognitive decline and motor dysfunction. Despite various treatments, his symptoms persisted within a month. Upon admission, the presence of neurological abnormalities suggestive of a central nervous system disorder raised suspicion of a cerebral lesion. Diagnostic tests revealed extensive brain lesions on imaging and the presence of atypical lymphocytes (flower cells) in the cerebrospinal fluid. The patient was diagnosed with lymphomatosis cerebri due to adult T cell leukemia/lymphoma, a rare presentation in the literature. Due to irreversible brainstem damage and poor neurological prognosis, aggressive treatment was not initiated, and the patient died, with an autopsy confirming the diagnosis.ConclusionLymphomatosis cerebri with adult T cell leukemia/lymphoma is very rare. It is crucial to promptly consider lymphomatosis cerebri as a differential diagnosis, particularly in cases of rapid cognitive decline and poor treatment response. Recognition of lymphomatosis cerebri as an important differential diagnosis for cognitive decline, and depression is necessary for timely intervention and management. Further research is required to better understand this unique and rare presentation in adult T cell leukemia/lymphoma.

Small-bowel Metastasis from Gastric Sarcomatoid Carcinoma: A Case Report

Sarcomatoid carcinoma, distinguished by its histological presentation of undifferentiated, spindle-shaped cells, is a rare variant of gastric cancer when contrasted with the more typical adenocarcinoma. Gastric cancer rarely metastasizes to the small bowel; these cancers typically arise from breast, lung, or melanoma origins. Herein, we present the case of a 70-year-old male who experienced melena and significant weight loss over 3 months. An esophagogastroduodenoscopy revealed an extensive ulcerative lesion in the lower curvature of the high body of the stomach, which is consistent with the results of the computed tomography scans. Surgery involving total gastrectomy and resection of multiple segments of small-bowel tumors was conducted. Pathological examination confirmed the presence of sarcomatoid carcinoma with poorly differentiated adenocarcinoma, along with metastases to the small intestine. This report highlights the aggressiveness of gastric sarcomatoid carcinoma, as well as the potential for the small bowel to be a potential metastasis site.

Relapsing meningitis and limbic encephalitis in anti-AQP4-Ab-associated neuromyelitis optica spectrum disorder.

neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease mainly affecting optic nerves and the spinal cord. Due to the potentially irreversible tissue damage, prevention of relapses is of utmost importance. We describe the atypical clinical course and pathology results of a patient with anti-aquaporin-4 antibody (anti-AQP4-Ab)-associated NMOSD who developed aseptic meningitis followed by limbic-encephalitis-like presentation with extensive brain lesions upon treatment with rituximab and tocilizumab. The patient developed subacute cognitive decline with magnetic resonance imaging (MRI) evidence of extensive brain white matter lesions. In the hypothesis of an opportunistic brain infection, she underwent brain biopsy of the temporal pole. Pathology results revealed typical NMOSD findings with complement activation, supporting the hypothesis of an atypical presentation of anti-AQP-Ab-associated NMOSD. Accordingly, treatment with the complement-targeting drug eculizumab was started, leading to a dramatic clinical and MRI improvement. aseptic meningitis and limbic encephalitis could represent a rare phenotype of anti-AQP4-Ab-associated NMOSD.

Associated Toxicity in Immunosuppressed Patients with Enfortumab Vedotin - An Essential Differential Diagnosis - Case Report

Enfortumab vedotin is an Antibody-Drug Conjugate (ADC) used to treat urothelial cancer. It has recently been associated with reports of Stevens Johnson syndrome/Toxic Epidermal Necrolysis (TEN). I report the clinical case of a 74-year-old man who developed an extensive skin lesion, clinically mimicking TEN. Considering differential diagnoses is essential as it can have implications for the prognosis and treatment of the disease. Further investigation is needed to ascertain real cases of toxic epidermal necrolysis versus opportunistic infections and/or other toxicities due to chemotherapy.

Spinal hydatid disease: A case report

Introduction: The parasitic tapeworm Echinococcus granulosus causes cystic echinococcosis, also known as hydatidosis. It is a serious medical condition that can show up in a lot of different ways. Although spinal involvement occurs in about 45% of bone echinococcosis cases, it represents only 0.5–4% of all echinococcosis cases. The disease can spread to the spine through hematogenous dissemination, direct invasion, or cerebrospinal fluid seeding from ruptured cysts. While the liver and lungs are the most commonly affected organs, spinal involvement can lead to severe complications, including radiculopathy, motor deficits, and paraparesis. Imaging, such as computed tomography (CT) and (MRI), typically makes the diagnosis by revealing cystic and osteolytic lesions. Case Report: The patient is a 51-year-old male from the Kakheti region (a region in Georgia) who presented with progressive generalized weakness, nausea, vomiting, and lumbar pain. He had a history of spinal echinococcosis, diagnosed 15 years ago, but was unable to complete antiprotozoal treatment due to intolerance to albendazole. Over the years, his condition deteriorated, leading to lower paraplegia and urinary incontinence, necessitating a suprapubic cystostomy. Imaging revealed extensive septated cystic lesions in Th4-S1, which spread to the ribs and subcutaneous tissues. Despite neurosurgical intervention to reduce the cyst burden, the infestation persisted. Multiple hospitalizations were required for complications, such as urinary tract infections and pneumonia. Joint supervision managed the patient’s condition, but he continued to experience spherocyte discharge from numerous fistulas. Conclusion: This case underscores the severe and chronic nature of spinal echinococcal infection, particularly when complete antiprotozoal treatment is not feasible. The patient did not experience severe neurological complications despite the extensive disease burden and the development of multiple vertebral-cutaneous fistulas, possibly due to the continuous drainage of spherocytes. This unusual clinical course highlights the importance of comprehensive management and the potential impact of innovative approaches on managing complex parasitic infections.

Clinical descriptive and long-term outcome of melanocytic uveal lesions in young dogs: 40 cases (45 eyes) including 13 cases of sector iridectomy.

To describe the clinical features surgical technique, early and long-term outcome with or without surgery, and histopathological findings of melanocytic anterior uveal lesions in young dogs. Medical records of dogs at a guide dog facility removed from training due to a pigmented iris lesion were reviewed from 2014 to 2021. Selected dogs had surgical iridectomies performed. Iridal melanocytic lesions were characterized as well-delineated, pigmented, and flat (nevus) or raised (mass) lesions of the iris. Forty dogs (18 Labrador retrievers, 18 German shepherd dogs, 1 Golden retriever, 3 Labrador/Golden mixes) ranging from 0.5 to 3.1 years of age were affected unilaterally (n = 35) or bilaterally (n = 5). Sector iridectomy was performed in 13 dogs with prominent and well-isolated mass lesion and enucleation was carried out in 2 dogs with extensive lesions, while all other cases were monitored without surgical intervention. Postoperative complications included dyscoria (13/13), focal posterior synechia (9/13) and focal nonprogressive cataract (8/13). All eyes remained visual and comfortable up to 6.2 years post-iridectomy with no clinically identifiable local recurrence. Histopathology was consistent with uveal melanocytoma in all samples obtained surgically. All cases that did not undergo surgery remained free of complications up to 4.5 year post diagnosis. Melanocytic anterior uveal lesions may be overrepresented in certain lineages of breeds and be present at a young age. While none of the eyes developed complications when monitored without surgery, early surgical excision of the mass by sector iridectomy yields noteworthy functional outcome and retention of a comfortable globe.

Alveolar Bone Actinomycosis Affecting a Pediatric Patient: Diagnosis and Conservative Management.

Actinomycosis is a rare infection that involves soft and bone tissues caused by gram-positive, anaerobic filamentous bacteria, usually Actinomyces israelii. About 3% of all cases affect children. Not uncommonly, actinomycosis is initially diagnosed as neoplasm or other granulomatous diseases. Paediatric actinomycosis affecting the jaws is rare. To date, 20 and 1 case affecting the mandible and maxilla, respectively, have been reported. A 4-year-old girl was referred presenting an extensive symptomatic ulcerative lesion with bone exposure in the posterior region of the right maxilla two months ago. One month before, she has been diagnosed with scarlet fever. The lesion progressed, damaging the supporting periodontal tissue. After surgical removal of necrotic bone and deciduous molar, the microscopy revealed actinomycosis, which showed excellent healing after local treatment with hydrogen peroxide solution and adequate oral hygiene. Although actinomycosis of the jaws affecting pediatric patients is rare, paediatric dentists must be aware of their clinicopathological characteristics, with therapeutic and prognostic impact.

Hybrid interventions on distal sections of the main arteries in extended chronic occlusions of the superficial femoral artery in patients with critical limb ischemia

AbstractBackground. Over two thirds of patients with CLI present with SFA disease, often a long CTOwith patent proximal popliteal artery and extensive occlusive lesions in the crural vessels. Westudied a series of hybrid interventions to treat this multilevel disease as an alternative to conventionalapproach.Aim. To improve the results of revascularization of the lower limb in cases of extended occlusionof the SFA in combination with crural runoff.Materials and Methods: A total of 40 patients (25% women; mean age 69.5 years), all with Rutherfordclass 5-6 disease, were included in the study. Angiography showed long (&gt;200 mm) SFA CTOin all cases (100%) accompanied by CTO of distal popliteal artery (n=9; 22.5%); all crural arteries(n=26; 65%) or all crural arteries but the peroneal (n=7; 17.5%).We performed femoropopliteal bypass with autologous vein in all patients (100%) followed byballoon angioplasty of distal popliteal and/or crural arteries done either on the same day (n=22;55%) or 2-14 days later (n=18; 45%). Direct angiosomic revascularization was achieved in 36 patients(90%).We used a series of 46 consecutive patients who underwent femoral tibial bypass as historic control.Results. The 30-day mortality and graft failure rate were 2.5% vs 4.3% (p&gt;0.05) and 5% vs 13%(p&lt;0.05) after hybrid and tibial bypass interventions, respectively.At 1 year the primary patency of bypass and amputation-free survival were 77.7% (95% CI 61.7-93.7) vs 57.1% (95% CI 42.9-71.3) and 82.1% (95% CI 66.8-97.4) vs 69.6% (95% CI 56.1-83.1) afterhybrid intervention and tibial bypass, respectively (all non-significant).Conclusions. Compared to femoral tibial bypass, a hybrid intervention comprised of a bypass to apatent popliteal artery and subsequent crural angioplasty decreased the early failure rate withoutany negative effect on the long-term outcomes in CLI patients with long SFA CTO and extensiverunoff disease.

Presurgical Mapping With Ultra-high Frequency Ultrasound of Hidradenitis Suppurativa Lesions Treated With Wide Local Excision and Secondary Intention Healing.

Hidradenitis suppurativa (HS) is a challenging chronic inflammatory condition often requiring surgical intervention, such as wide local excision. Preoperative mapping with ultra-high frequency ultrasound (UHFUS) enables detailed assessment of lesion extension, particularly identifying tunnels and fistulas, facilitating surgical planning. This study aimed to analyze recurrence rates of HS lesions previously mapped with UHFUS and treated with wide excision and secondary intention healing. A retrospective single-center study enrolled 40 patients with HS undergoing wide excision surgery after UHFUS mapping. Patients were assessed weekly until complete healing and then every 3 months, evaluating clinical and sonographic signs of relapse and pain using the visual analogue scale. Results showed a population predominantly composed of women (65%) with a mean age of 39 years and a medium HS-Hurley score of 2.5. Over a 22-month follow-up, only 10% experienced clinical relapse, achieving an 90% total remission rate. Pain scores decreased significantly from Week 0 to Week 4. The study highlights the clinical challenge of HS management, particularly regarding surgical planning and lesion margin definition. The remission rate observed in this study suggests the effectiveness of UHFUS-guided surgical approaches. Future studies should extend observation periods to further validate these findings.

Intracardiac echocardiography guided anatomical ablation of the arcuate ridge for drug refractory inappropriate sinus tachycardia.

Inappropriate sinus tachycardia (IST) is a common condition with frequently not tolerated beta-blockers or ivabradine and a high rate of complication in ablation strategy; we describe an alternative anatomical approach of sinus node (SN) modulation. This retrospective study describes a case series of 6 patients from two centers diagnosed with symptomatic IST undergoing SN ablation. The mean age was 40.6 ± 13.9 years; five of the six patients were female, 100% of patients reported heart palpitations, and 66% reported dizziness, the average heart rate(HR) on a 24-h Holter was 93.2 ± 7.9 bpm. HR during the first stage of a stress test using a standard Bruce protocol was 150 ± 70 bpm, The average HR on 24-h Holter postablation was 75 ± 5.6 bpm, the sinus rate HR during stage 1 of a Bruce protocol exercise stress test was 120 ± 10 bpm. This is the first case series reporting the acute and long-term results of a novel anatomical approach for SN modulation to treat IST targeting the arcuate ridge(AR) under intracardiac echography(ICE) guidance. The novel anatomic ICE-guided catheter ablation approach aimed to identify the earliest activation at the AR with an extension of RF lesions towardits septal region seems effective and safe to modulate the SN in symptomatic patients with IST refractory to medical treatment.

LILRB4 on multiple myeloma cells promotes bone lesion by p-SHP2/NF-κB/RELT signal pathway

BackgroundLeukocyte Ig-like receptor B family 4 (LILRB4) as an immune checkpoint on myeloid cells is a potential target for tumor therapy. Extensive osteolytic bone lesion is the most characteristic feature of multiple myeloma. It is unclear whether ectopic LILRB4 on multiple myeloma regulates bone lesion.MethodsThe conditioned medium (CM) from LILRB4-WT and -KO cells was used to analyze the effects of LILRB4 on osteoclasts and osteoblasts. Xenograft, syngeneic and patient derived xenograft models were constructed, and micro-CT, H&E staining were used to observe the bone lesion. RNA-seq, cytokine array, qPCR, the activity of luciferase, Co-IP and western blotting were used to clarify the mechanism by which LILRB4 mediated bone damage in multiple myeloma.ResultsWe comprehensively analyzed the expression of LILRB4 in various tumor tissue arrays, and found that LILRB4 was highly expressed in multiple myeloma samples. The patient’s imaging data showed that the higher the expression level of LILRB4, the more serious the bone lesion in patients with multiple myeloma. The conditioned medium from LILRB4-WT not -KO cells could significantly promote the differentiation and maturation of osteoclasts. Xenograft, syngeneic and patient derived xenograft models furtherly confirmed that LILRB4 could mediate bone lesion of multiple myeloma. Next, cytokine array was performed to identify the differentially expressed cytokines, and RELT was identified and regulated by LILRB4. The overexpression or exogenous RELT could regenerate the bone damage in LILRB4-KO cells in vitro and in vivo. The deletion of LILRB4, anti-LILRB4 alone or in combination with bortezomib could significantly delay the progression of bone lesion of multiple myeloma.ConclusionsOur findings indicated that LILRB4 promoted the bone lesion by promoting the differentiation and mature of osteoclasts through secreting RELT, and blocking LILRB4 singling pathway could inhibit the bone lesion.

Surgical Management of Extradural Tumors at the Craniovertebral Junction – Insights from a Tertiary Care Center

Craniovertebral junction (CVJ) tumors are challenging due to their unique anatomical location. This study aimed to evaluate the complexities in dealing with such precarious CVJ extradural lesions over the decade. Twenty-seven patients of extradural CVJ tumors operated between 2009 and 2018 were included. The demographic details, neurological status, surgical approach, extent of resection, type of fixation, complications, and outcome at final follow-up were recorded for each patient. The mean age of the patients was 39.5±20years. Most (17/27) of the patients had involvement of a single level. Clivus was the most common (9/17) involved region followed by atlas (7/17) vertebrae. Majority of the patients (13/27) were operated through the posterior-only approach. About 15 patients (55.5%) had instability or extensive lesions that necessitated posterior fixation. None of the patients underwent anterior fixation. Gross and near total excision were achieved in 10 patients (37%) and 3 patients (11%) respectively while 14 patients underwent subtotal excision of tumor. On histopathological analysis, clival chordoma (8/27) was found to be the most common pathology followed by giant cell tumor (6/27), plasmacytoma (4/27), and multiple myeloma (2/27). Most patients (13 out of 27) had the same neurological status after the surgery. Six patients (22%) improved post-operatively with decreased weakness and spasticity. Thirteen (48%) patients underwent adjuvant radiotherapy. This retrospective study provides valuable insights into managing extradural CVJ tumors and highlights the importance of individualized approaches for optimal outcome.

Fibroadipose Vascular Anomaly: Diagnosis and Treatment

Fibro-Adipose Vascular Anomaly (FAVA) is a recently identified type of vascular malformation predominantly affecting adolescent females. Comprising abnormal adipose and vascular components, FAVA is frequently misdiagnosed as other vascular anomalies. It primarily manifests with pain, functional impairment, and musculoskeletal symptoms, particularly in the lower extremities. Accurate diagnosis requires a combination of clinical, radiologic, and histopathologic evaluation, with MRI and ultrasound being the primary imaging tools. Management of FAVA is multidisciplinary and tailored to individual patients. Interventional radiology procedures, such as percutaneous cryoablation, sclerotherapy, and embolization, are effective in long term control of symptoms. Cryoablation is particularly successful in alleviating pain and improving function. Surgical resection is reserved for specific cases with extensive lesions involving joints or when there is severe muscle or joint dysfunction. Additionally, sirolimus, an mTOR inhibitor, has shown promise in symptom relief, although further research is needed to confirm its long-term efficacy. Early diagnosis and treatment are essential for improving the quality of life in FAVA patients. Advances in imaging and treatment strategies have enhanced the ability to manage this complex and rare condition effectively.

Long-term cognitive outcomes in Susac syndrome: A case series

Susac syndrome (SuS) presents with encephalopathy, visual disturbances, and hearing loss from immune-mediated microvascular occlusion. While acute SuS is well-described, long-term cognitive outcomes with current treatments are underknown. We assessed ten SuS patients treated in accordance with evidence-based guidelines using immunotherapies targeting humoral and cell-mediated pathways. Patients were followed for a median 3.6 years. Initially, cognition inversely correlated with corpus callosum lesions on MRI. All reported cognitive improvement; 5/10 patients had residual deficits in visual attention and executive function. Early, aggressive treatment was associated with good outcomes; extensive early corpus callosum lesions may identify patients at-risk of persistent cognitive deficits.

Imaging of oral cavity and oropharyngeal masses: clinico-radiologic correlation

BackgroundClinical diagnosis of the masses of the oropharynx and the oral cavity is usually straightforward; however, deep extension of lesions should be assessed by imaging. Thirty patients with suspected masses in oral cavity and oropharynx were enrolled in the present study. Contrast-enhanced CT and MRI were used for imaging of all patients, and superficial ultrasound was used as screening (whether the mass was accessible to ultrasound or not). The aim of this study was to evaluate clinical impact of combined imaging modalities for assessment of intraoral and oropharyngeal masses.ResultsThere was a statistically significant difference between CT and MRI regarding the detected tumor size, lymph node and adjacent structures. CT had a sensitivity of 77.78% and specificity of 75% in the detection of malignancy. A low apparent diffusion coefficient can detect malignancy with 61.11% sensitivity and 91.67% specificity.ConclusionsThe radiographic diagnosis of the oral cavity presents a complex challenge. According to the unique presentation of each patient, combined CT and MRI imaging will enhance the identification and characterization of lesions in the oral cavity and oropharynx. There is a secondary, limited role for ultrasonography.

Hemiplegic (unilateral) cerebral palsy in northern Stockholm: Intellectual disability and epilepsy

PurposeThe purpose of this study was to describe intellectual disability and its association with epilepsy and brain imaging, in a population-based group of children with hemiplegic (unilateral) cerebral palsy, previously investigated and published in 2020. Materials and methodsForty-seven children of school age in northern Stockholm, fulfilling the Surveillance of Cerebral Palsy in Europe-criteria of hemiplegic (unilateral spastic) cerebral palsy, were invited to participate in the study. Twenty-one children consented to participate. A WISC (Wechsler Intelligence Scale for Children)-test was performed by an experienced psychologist. ResultsIn the study population of twenty-one children, 57 % (n 12) displayed uneven cognitive profiles, 38 % (n 8) intellectual disability and 62 % (n 13) had a normal IQ. 43 % (n 9) developed epilepsy. Children with extensive brain lesions had more severe intellectual disability. ConclusionsIn this study intellectual disability and/or epilepsy were associated with the type and extent of the underlying brain lesion. Intellectual disability and uneven cognitive profiles were common. We therefore recommend individual cognitive assessment to ensure an optimal school start.