Symptoms In Patients Research Articles

Cryptogenic strokes and neurological symptoms of Fabry disease

IntroductionFabry disease (FD) is the second most common lysosomal storage disorder. It mainly affects young people. FD can be characterized by neurological symptoms that can occur in both the central and peripheral nervous systems. Cerebrovascular involvement is common in FD and is considered an important cause of cryptogenic strokes. This study aimed to describe the neurological symptoms in patients with FD in general and, specifically, to determine the frequency of association between this disease and cerebrovascular manifestations in our environment.Materials and methodsThis retrospective, observational, cross-sectional study included all patients in the FD registry of the nephrology and cardiology Departments of our center. A descriptive analysis of demographic, neurological, clinical, and neuroimaging variables was performed, with a particular focus on their association with stroke or other cerebrovascular events prior to diagnosis.ResultsA total of 25 patients were included, with 14 (68%) of them being women. The median age of the patients was 52 years (relative intensity of collaboration [RIC] = 24.5). The patients belonged to five families with specific galactosidase alpha gene (GLA) mutations. Neuroimaging was performed in 13 (52%) patients, most of whom did not have neurological symptoms but had normal imaging results. Only 2 (8%) patients had nonspecific white matter hyperintensities. Among the 11 (44%) patients with neurological involvement, the most common symptom was pain in the extremities (32%). Stroke was identified in only one patient (4%), which occurred prior to the diagnosis of FD and was determined to be of cardioembolic etiology.DiscussionFD is found to be associated with several neurological symptoms. In our study, the most common neurological symptom was limb pain, which had varied characteristics. On the other hand, the incidence of stroke was significantly lower than that expected.

Autoimmune Thyroid Diseases and Microscopic Colitis: A Nationwide Matched Case-Control Study in Sweden.

Microscopic colitis (MC), comprising collagenous colitis (CC) and lymphocytic colitis (LC), is an inflammatory condition of the colon, characterized by watery diarrhoea. Previous studies suggest an association between autoimmune thyroid diseases (AITDs) (Hashimoto's thyroiditis and Graves' disease) and MC; however, large-scale histology studies are lacking. We conducted a nationwide, matched case-control study. Patients with biopsy-confirmed MC diagnosed between 2006 and 2017 were identified through the population-based histopathology cohort ESPRESSO. Data on AITDs and covariates were retrieved from Swedish national healthcare registers. Odds ratios (ORs) for MC associated with prior AITDs were estimated using conditional logistic regression. Sibling comparisons were performed to minimize shared genetic and environmental confounding. Among 10,301 MC cases and 48,712 controls, AITDs were significantly more prevalent in MC patients (12.0%) than in controls (7.8%), yielding an adjusted OR of 1.65 (95% confidence interval (CI): 1.54-1.77). This association was attenuated but remained significant in sibling analyses (OR: 1.26; 95%CI: 1.11-1.43) The association was stronger in patients diagnosed with MC before age 50 (OR: 2.41; 95%CI: 2.02-2.89). Subgroup analyses revealed no difference between CC and LC or between sexes. Individuals with AITDs are at an increased risk of developing MC. That this association was robust across various subgroups may be indicative of shared underlying mechanisms. Our findings highlight the importance of being vigilant of gastrointestinal symptoms in patients with AITDs and that patients with persistent symptoms despite achieving euthyroidism should be evaluated for MC.

Dermatological Manifestations of Diabetes Mellitus and Its Complications

Diabetes mellitus (DM) is a chronic metabolic disorder associated with late diagnosis due to the absence of early symptoms in patients. Cutaneous manifestations of DM often serve as indicators of insulin resistance and vary with disease progression, highlighting severity and systemic involvements. With an increasing global burden and rapidly rising prevalence, skin findings associated with DM have become more crucial for the rapid identification and treatment of underlying metabolic processes. However, current challenges in identification include inaccurate or missed detection in darker-skinned populations, which may be attributed to the lack of inclusion of diverse skin types in textbooks and research studies. This review provides clinicians with comprehensive updates on the diagnosis and treatment of cutaneous signs, complications, comorbidities, and medication-associated side effects associated with DM, and the treatment of these manifestations.

Serotonergic dysfunction in patients with impulse control disorders in Parkinson's disease.

Impulse control disorders (ICDs) are frequent and particularly distressing neuropsychiatric symptoms in patients with Parkinson's disease (PD) which are related to impaired behavioural inhibition. Multiple PET imaging studies indicate that striatal dopaminergic abnormalities contribute to hyperdopaminergic functioning in PD patients with ICD (PDICD+) and to the dysregulation of the limbic fronto-striatal networks which are critical for reward-related decision impulsivity. However, the serotonergic system is central to response inhibition and plays a critical role in neuropsychiatric symptoms in PD, but its role remains undetermined in PDICD. We hypothesized that PDICD+ patients exhibit serotonergic dysfunction within the cortico-striato-pallido-thalamic circuits involved in the inhibitory control of behaviour and decided to investigate the pre- and post-synaptic serotonergic innervation using two highly-specific PET tracers for the serotonin transporter (SERT) using [11C]DASB and the 5-HT2A receptor using [18F]altanserin. In this prospective, case-control, double-tracer PET study, we recruited 15 PDICD+ patients, 15 PDICD- patients and 15 healthy controls, matched for age and sex, and compared the availability of [11C]DASB and [18F]altanserin using permutation-based analysis. PDICD+ patients had one (n=9) or multiple ICDs (n=6), consisting in hypersexuality (n=8), compulsive eating (n=6), compulsive shopping (n=5) and pathological gambling (n=4) and were characterized by greater choice impulsivity (impaired delay discounting for monetary rewards) and greater urgency with more severe depressive and anxious symptoms. We demonstrate that PDICD+ patients had greater [11C]DASB binding in the posterior putamen and pallidum in comparison to PDICD- patients, corresponding to relatively preserved presynaptic SERT availability within the subcortical sensorimotor network involved in response inhibition. In addition, cortical [18F]altanserin binding was greater in PDICD+ patients in the bilateral supplementary motor area, precentral gyrus and right dorsolateral prefrontal cortex, involving the sensorimotor and associative networks which regulate behavioural inhibition. Furthermore, we show that pre- and post-synaptic serotonergic dysfunction subserving action versus decision impulsivity in PD patients specifically followed the distinctive functional organization of the sensorimotor and associative fronto-striatal networks. Altogether, we demonstrate that serotonergic dysfunction related to ICDs in PD specifically involve the sensorimotor and associative cortico-striato-pallido-thalamic circuits involved in inhibitory control. Thus, serotonergic dysfunction contributes to the mechanisms related to the vulnerability and development of ICDs in PD patients, beyond the known dopaminergic abnormalities in the limbic fronto-striatal circuit.

Latent profile analysis of anxiety and related factors among stroke patients' spouses.

To explore the potential classification of anxiety symptoms in stroke patients' spouses and analyze the characteristics of each category. From November 2019 to August 2020, a total of 224 stroke patients in the department of neurology of a tertiary hospital in Henan Province, and 224 spouse caregivers were conveniently selected. The general information questionnaire, Generalized Anxiety Disorder 7-item, the Patient Health Questionnaire 9-item scale, and modified Rankin Scale was used to assess patient and caregiver general information, anxiety, depression and patient prognosis, respectively. Latent profile analysis was used to analyze stroke patients' spouse anxiety symptoms, and polynomial logistic regression analysis was performed to assess factors associated with each category. The mean age of the patients were 62.54 years and the patients' spouses were 62.23 years. The patients' spouse anxiety symptoms were categorized into four groups: high anxiety-worry (13.4%); high anxiety-adaptive (58.9%); medium anxiety-high toughness (7.6%); anxiety-low risk (20.1%). There is heterogeneity in the anxiety symptoms of spouse caregivers of stroke patients, and nurses should develop targeted interventions based on the anxiety characteristics of different potential categories of spouse caregivers and their influencing factors in order to improve their anxiety symptoms.

Psychosomatic and Psychological Impact of Hepatitis C: A Cross-Sectional Study of Depression, Fibrosis, and Somatic Symptoms in Treatment-Naive and Treatment-Experienced Patients Who Achieved Sustained Virologic Response

Psychosomatic and Psychological Impact of Hepatitis C: A Cross-Sectional Study of Depression, Fibrosis, and Somatic Symptoms in Treatment-Naive and Treatment-Experienced Patients Who Achieved Sustained Virologic Response

Shared decision making in routine oncology appointments with Black patients with lung cancer.

Poor clinician-patient communication may contribute to racialized inequities in cancer symptom burden. Shared decision-making (SDM) enhances clinician-patient communication, and could contribute to health equity for Black patients with cancer. However, research on SDM is limited for Black patients with cancer. This multi-method longitudinal observational study examined SDM during routine oncology follow-ups for patients with advanced lung cancer. We analyzed SDM reported by clinicians (n = 6), self-identified Black patients with lung cancer (n = 30), and coded from patient visit recordings (n = 20). We described the symptom management conversations, and examined how SDM related to patient satisfaction and symptom severity with two-sided correlations. Most patients (85.0%) asked questions during appointments and discussed cancer-related symptoms (95.0%), most commonly pain/neuropathy (65.0%). Though coded SDM during symptom discussions was low, providers and patients reported high levels of SDM. Coded SDM did not statistically significantly correlate with post-appointment satisfaction (r = -.01, p > .10) or symptom burden (r = .04, p > .10). However, patient-reported SDM did relate to post-appointment satisfaction (r = .72, p = .08) and symptom burden (r = .35, p = .08) one month later. Through detailed multi-method analysis, we found that coded SDM did not correspond to patient and physician-reported SDM during routine oncology appointments. Patient-reported SDM correlated to several better physical and mental health outcomes as well as overall satisfaction a month later. Our findings highlight the complexities of clinician-patient communication and the importance of studying these processes for Black patients with cancer. Future research should develop culturally-relevant methods of assessing SDM with Black patients and understand Black patients' communication needs.

How to Best Measure and Characterize Symptoms of Patients with Pelvic Floor Disorders

AbstractPelvic floor disorders (PFDs) are common and can be associated with various symptoms, including fecal incontinence, constipation, urinary incontinence, lower urinary tract symptoms, sexual dysfunction, and pelvic pain. Characterizing symptoms can be challenging due to limitations in patient reporting, provider ability to collect data, and the instruments used to collect the data. Symptoms are assessed using patient-reported outcome measures (PROMs), instruments that can be generic or disease-specific. Here, we describe the frequently used and recommended instruments for assessing symptoms of PFDs. We review the Pelvic Floor Disorders Consortium (PFCD) consensus document called IMPACT (Initial Measurement of Patient-reported Pelvic Floor Complaints Tool), a collection of recommended instruments in their unaltered form as well as within a consolidated short form. A multidisciplinary approach to patient care and interpretation of data is important to best characterize symptoms of PFDs. Future steps should include further collaborating across specialties and with patients to develop more condition-specific and patient-centered PROMs.

Testing a Dashboard Intervention for Tracking Digital Social Media Activity in Clinical Care of Individuals With Mood and Anxiety Disorders: Protocol and Design Considerations for a Pragmatic Randomized Trial.

Mood and anxiety disorders are prevalent mental health diagnoses. Numerous studies have shown that measurement-based care, which is used to monitor patient symptoms, functioning, and treatment progress and help guide clinical decisions and collaboration on treatment goals, can improve outcomes in patients with these disorders. Including digital information regarding patients' electronic communications and social media activity is an innovative approach to augmenting measurement-based care. Recent data indicate interest and willingness from both mental health clinicians and patients to share this type of digital information in treatment sessions. However, the clinical benefit of systematically doing this has been minimally evaluated. This study aims to develop an electronic dashboard for tracking patients' digital social activity and a protocol for a pragmatic randomized trial to test the feasibility and efficacy of using the dashboard in real-world clinical care of patients with depression or anxiety disorders. We developed a personalized electronic dashboard that tracks patients' electronic communications and social media activity, visualizes data on these interactions through key graphics and figures, and provides a tool that can be readily integrated into routine clinical care for use by clinicians and patients during treatment sessions. We then designed a randomized trial to evaluate the feasibility and effectiveness of using the electronic dashboard in real-world care compared to treatment as usual. The trial included patients aged ≥12 years with a mood or anxiety disorder who were receiving treatment in outpatient psychiatry clinics in the Johns Hopkins Health System and the Kennedy Krieger Institute. The primary outcome includes changes in patient-rated depression symptoms. Secondary outcomes include changes in patient-rated anxiety symptoms and overall functioning. Exploratory analyses examine the impact of the intervention on measures of therapeutic alliance and the detection of clinically actionable targets. We successfully developed an electronic dashboard for tracking patients' electronic communications and social media activity, and we implemented a protocol for evaluating the feasibility and efficacy of using the dashboard in routine care for mood or anxiety disorders. The protocol was approved by the Johns Hopkins University School of Medicine Institutional Review Board. In this study, we report the technological, ethical, and pragmatic considerations in developing the dashboard and testing it in a real-world setting. The integration of an electronic dashboard to monitor digital social activity in mental health care treatment is novel. This study examines the feasibility and effectiveness of the dashboard and the challenges in implementing this protocol. The lessons learned from developing and implementing the study will inform ongoing discussions about the value of gathering collateral information on patients' digital social activity and how to do so in a way that is acceptable and clinically effective. ClinicalTrials.gov NCT03925038; https://clinicaltrials.gov/study/NCT03925038. DERR1-10.2196/63279.

Discovering root causal genes with high-throughput perturbations.

Root causal gene expression levels - or root causal genes for short - correspond to the initial changes to gene expression that generate patient symptoms as a downstream effect. Identifying root causal genes is critical towards developing treatments that modify disease near its onset, but no existing algorithms attempt to identify root causal genes from data. RNA-sequencing (RNA-seq) data introduces challenges such as measurement error, high dimensionality and non-linearity that compromise accurate estimation of root causal effects even with state-of-the-art approaches. We therefore instead leverage Perturb-seq, or high-throughput perturbations with single-cell RNA-seq readout, to learn the causal order between the genes. We then transfer the causal order to bulk RNA-seq and identify root causal genes specific to a given patient for the first time using a novel statistic. Experiments demonstrate large improvements in performance. Applications to macular degeneration and multiple sclerosis also reveal root causal genes that lie on known pathogenic pathways, delineate patient subgroups and implicate a newly defined omnigenic root causal model.

Discovering root causal genes with high-throughput perturbations

Root causal gene expression levels – or root causal genes for short – correspond to the initial changes to gene expression that generate patient symptoms as a downstream effect. Identifying root causal genes is critical towards developing treatments that modify disease near its onset, but no existing algorithms attempt to identify root causal genes from data. RNA-sequencing (RNA-seq) data introduces challenges such as measurement error, high dimensionality and non-linearity that compromise accurate estimation of root causal effects even with state-of-the-art approaches. We therefore instead leverage Perturb-seq, or high-throughput perturbations with single-cell RNA-seq readout, to learn the causal order between the genes. We then transfer the causal order to bulk RNA-seq and identify root causal genes specific to a given patient for the first time using a novel statistic. Experiments demonstrate large improvements in performance. Applications to macular degeneration and multiple sclerosis also reveal root causal genes that lie on known pathogenic pathways, delineate patient subgroups and implicate a newly defined omnigenic root causal model.

Impact of Psychosocial Interventions on Depression in Chronic Kidney Disease: A Systematic Review and Meta-Analysis.

Depression is prevalent among individuals with chronic kidney disease (CKD) and those undergoing dialysis, with significant impacts on morbidity and mortality. This systematic review and meta-analysis was done to evaluate the efficacy of psychosocial interventions in managing depressive symptoms in patients with CKD. This systematic review and meta-analysis adhered to PRISMA guidelines. A literature search was conducted across PubMed, Embase, Google Scholar, and Cochrane Library databases from January 2007 to July 2024. Randomized controlled trials (RCTs) investigating psychosocial interventions in CKD patients (Stage 4 or 5 or on hemodialysis) were included. The primary outcome was the change in depressive symptoms, measured by standardized clinical tools. Quality of life was a secondary outcome. Data extraction and bias assessment were conducted using ROB-2 and GRADEpro GDT tools. Twelve studies with a total of 792 participants (420 in the intervention group and 372 in the control group) were included. Cognitive-behavioral therapy (CBT) was the most common intervention. Psychosocial interventions significantly reduced depressive symptoms compared to routine care (mean difference [MD]: -4.22; 95% CI: -6.67, -1.76; P = 0.0008). High heterogeneity (I2 = 89%) was noted. Sensitivity analysis confirmed the robustness of the results. The impact on quality of life was not statistically significant (MD: 0.94; 95% CI: -0.61, 2.49; P = 0.24). Moderate-quality evidence suggests that psychosocial interventions effectively reduce depressive symptoms in CKD patients. While no significant improvement in quality of life was observed, these interventions provide an alternative to pharmacological treatments, potentially minimizing drug-related side effects.

Gastric-filling ultrasonography to evaluate gastric motor function in patients long-term bedridden undergoing stroke

Gastric-filling ultrasonography to evaluate gastric motor function in patients long-term bedridden undergoing stroke

Disrupted topological organization of brain connectome in patients with chronic low back related leg pain and clinical correlations

Chronic pain is associated with persistent alterations in brain structure and function. However, existing research has not fully explored the relationship between brain network topological properties and clinical symptoms in patients with chronic low back-related leg pain (cLBLP). In this study, we collected resting-state functional and structural magnetic resonance imaging data, along with clinical symptom evaluation data, from 32 cLBLP patients and 31 healthy controls. A large-scale complex network analysis was conducted to evaluate the global and nodal topological properties of functional and structural brain networks. Statistical analyses were performed to determine the associations between network properties and clinical variables. The results showed significant alterations in both global and nodal topological properties of functional and structural brain networks in cLBLP patients compared to healthy controls. Additionally, a direct correlation was found between structural network properties and spatial discrimination ability, measured by two-point tactile discrimination values, while no significant association was observed between functional connectivity and spatial discrimination. This study demonstrates that cLBLP patients exbibit a decreased local efficiency of functional connectivity network and increased compensatory global efficiency of structural connectivity network. Notably, alterations in the structural connectome, rather than the functional connectome, play a more significant role in deterioration of foot tactile spatial acuity in cLBLP patients.Trial registration: This trial was registered in the Chinese Clinical Trial Registry with the registration number ChiCTR2200055321 on 2022-01-06.

Neuromodulation for the Treatment of Refractory Chronic Renal Pain: Clinical Report and Literature Review

Background: Chronic renal pain secondary to urological pathology can severely affect a patient’s quality of life. Utero Pelvic Junction Obstruction (UPJO) and Loin Pain Hematuria Syndrome (LPHS) are two conditions known to cause chronic renal pain that can be refractory to conventional treatments. Recent publications demonstrate neuromodulation as an effective treatment option for refractory renal pain. The purpose of this review is to (1) provide evidence from a patient case demonstrating the expanding clinical application of spinal cord stimulation (SCS) for refractory renal pain; (2) provide a review of the literature surrounding UPJO/LPHS and SCS; and (3) express a call to action to investigate the clinical applications of neuromodulation and SCS to treatment-resistant genitourinary pathologies. Methods: We performed a search across PubMed and Web of Science databases to search for patients with UPJO/LPHS who had chronic renal/flank pain and were treated with SCS. Results: In our review, we included five case reports/series (including our own) of eight patients who had chronic flank pain secondary to the genitourinary pathologies UPJO and LPHS. Some patients have been having renal pain for up to 20 years, with all patients experiencing significant or complete alleviation of pain after SCS despite multiple failed attempts with other modalities. Five patients had complete resolution of pain and four patients were able to discontinue their pain medications entirely. Conclusions: SCS is gaining traction in its versatility in the management of various chronic pathologies beyond just CNS conditions. Specifically, UPJO and LPHS are examples of urogenital conditions that may benefit from using SCS. Our case shows an exciting opportunity for managing clinical symptoms in patients who have these conditions but have not undergone surgery for many reasons. Our review and clinical report suggest more research is needed in the application of SCS to genitourinary conditions and those experiencing refractory chronic pain.

Involvement of oxidative stress in post-acute sequelae of COVID-19: clinical implications

ABSTRACT Oxidative stress (OS) plays a key role in the pathophysiology of COVID-19 and may be associated with sequelae after severe SARS-CoV-2 infection. This study evaluated OS and inflammation biomarkers in blood from individuals with post-acute sequelae of COVID-19 (PASC). 64 male and female participants were distributed into three groups: healthy individuals (n = 20), acute COVID-19 patients (symptoms for <3 weeks, n = 15), and PASC patients (symptoms for >12 weeks, n = 29). Analyses included inflammatory cytokines, myeloperoxidase (MPO) activity, and OS markers, such as superoxide dismutase (SOD), catalase (CAT), glutathione S-transferase (GST), gamma-glutamyl transferase (GGT), reduced glutathione (GSH), uric acid (UA), thiobarbituric acid reactive substances (TBARS), and protein carbonyls (PC). Individuals with PASC showed increased IL-6 and IL-8. Both COVID-19 groups exhibited decreased SOD and CAT. GST decreased only in the acute group. Elevated GGT and GSH were found in the PASC group. High UA levels were observed in PASC individuals. There were no changes in TBARS values ⁣⁣in the PASC group. However, PC concentrations were elevated only in this group. Correlations were identified between inflammatory markers and OS parameters. These findings suggest that individuals with PASC pronounced OS, which potentially exacerbates disease complications. Monitoring OS biomarkers could aid in patient prognosis and management.

Dry Eye Syndrome: Mechanism, Diagnosis and Treatment Strategies

Introduction and Purpose: Dry eye syndrome is a set of ophthalmic complaints frequently reported by ophthalmology patients. It is a chronic, multifactorial disorder of the ocular surface that significantly impacts visual function and the quality of life of patients across all age groups. The condition is more prevalent in women and becomes more common with advancing age. Dry eye syndrome presents a wide range of symptoms with varying degrees of severity, contributing to the complexity of its diagnosis and treatment. This review examines the diagnostic approaches and management strategies for dry eye syndrome, with a particular focus on the most common underlying factors. Materials and Methods: A comprehensive survey of articles published in scientific journals was conducted via the online research platforms PubMed and Google Scholar. Articles were searched by entering keywords in the appropriate configuration: “dry eye syndrome,” “management” and ”diagnosis.” Description of current knowledge: Studies have indicated that the approach to diagnosing and managing dry eye syndrome is largely contingent on the underlying cause and the intensity of the patient's symptoms.

Central Retinal Vein Occlusion: Etiology, Clinical Presentation and Treatment

Introduction and Purpose: Retinal vein occlusion (RVO) occurs when the lumen of the retinal vein closes. Central retinal vein occlusion is the second most common retinal vascular disease. There are distinguished forms: central retinal vein occlusion (CRVO), hemiretinal vein occlusion (HRVO) and branch retinal vein occlusion (BRVO). Central retinal vein occlusion is a prevalent cause of visual impairment among the elderly. Currently, there are no proven methods for the prevention of this condition. Current therapy is based on treatment of possible complications (laser therapy, anti-VEGF injections, glucocorticosteroid injections). Central retinal vein occlusion (CRVO) is a disease that involves the sudden appearance of lesions on the fundus due to the closure of a venous vessel. As a result, the patient often experiences a significant deterioration in visual acuity, potentially leading to complete vision loss. Determining the epidemiology is difficult, and diagnosis is based mainly on a physical examination combined with a thorough ophthalmologic evaluation, supplemented by a number of additional tests. Materials and Methods: A comprehensive survey of articles published in scientific journals was conducted via the online research platforms PubMed and Google Scholar. Articles were searched by entering keywords in the appropriate configuration: “retinal vein occlusion”, “retina”, “visual impairment”. Description of current knowledge: Studies have indicated that the approach to diagnosing and managing central retinal vein occlusion is largely contingent on the underlying cause and the intensity of the patient's symptoms. Keywords: “retinal vein occlusion”, “retina”, “visual impairment”

Eyelid Margin Inflammation: Pathophysiology, Diagnosis and Management Approaches

Introduction and Purpose: Eyelid margin inflammation is a commonly reported syndrome of ophthalmic complaints. It is a chronic, multifactorial disorder of the eyelid margins that significantly impacts the visual function and quality of life of patients across all age groups. Establishing the epidemiology is challenging, and the diagnosis relies primarily on a physical examination combined with a thorough ophthalmological assessment, potentially supplemented by additional tests. The condition is recurrent, often necessitating long-term treatment. Successful management requires close collaboration between the specialist and the patient, which demands commitment and patience. Eyelid margin inflammation manifests through various symptoms, such as burning, itching, dryness, or a feeling of sand in the eyes. This condition is characterized by a wide range of symptoms with varying severity, contributing to the complexity of its diagnosis and treatment. This review examines the diagnostic approaches and treatment strategies for eyelid margin inflammation, focusing on the most common underlying factors. Materials and Methods: A comprehensive survey of articles published in scientific journals was conducted via the online research platforms PubMed and Google Scholar. Articles were searched by entering keywords in the appropriate configuration: “eyelid rim inflammation”, “ Meibomian gland dysfunction”, “demodex”. Description of current knowledge: Studies have indicated that the approach to diagnosing and managing eyelid margin inflammation is largely contingent on the underlying cause and the intensity of the patient's symptoms. Keywords: “eyelid rim inflammation”, “ Meibomian gland dysfunction”, “demodex”.

Conservative management of an expanding intracranial epidural abscess: illustrative case.

Management of intracranial epidural abscess (ICEA) typically requires a combination of surgical drainage and antibiotic therapy. However, the indications for neurosurgical drainage of ICEA have not been well established by evidence-based data and remain controversial. This article describes a case of ICEA that enlarged during antibiotic therapy but was managed successfully without neurosurgical drainage. A 13-year-old boy was admitted to the authors' hospital with a 6-day history of high fever, fatigue, and headache. Computed tomography and magnetic resonance imaging (MRI) revealed an ICEA in the right middle fossa with right-sided sinusitis. Initial empiric intravenous antibiotic therapy resulted in rapid improvement in clinical course. Despite clinical improvement, the abscess progressively enlarged by 158% after 2 weeks. Based on the patient's symptoms, age, and location of the lesion and considering the invasive surgical risks, neurosurgical drainage was not performed. Subsequently, the abscess began to decrease in size, and the patient was discharged after 5 weeks of hospitalization. Follow-up MRI at 6 months confirmed complete resolution of the abscess. Despite abscess enlargement, conservative management might be feasible when the patient demonstrates symptomatic improvement; thus, a tailored approach combining close monitoring with serial imaging is recommended. https://thejns.org/doi/10.3171/CASE24702.