Spontaneous Cases Research Articles

Spontaneous regression of a petroclival meningioma: illustrative case.

Spontaneous regression is relatively rare in meningiomas. Since meningiomas are known to have a relationship with sex-related hormones, spontaneous regression cases related to sex hormones have been reported. A 66-year-old man with a petroclival meningioma was radiologically followed up for 13 years. The tumor initially measured 2.535 cm3 and 2.521 cm3 on gadolinium-enhanced magnetic resonance imaging (MRI) and fast imaging employing steady-state acquisition MRI, respectively. However, the measurements decreased in the follow-up period to 0.977 cm3 and 0.98 cm3, respectively, demonstrating spontaneous regression of an asymptomatic meningioma located in a petroclival area. Continuous meticulous long-term follow-up revealed this phenomenon. It is important to retain the option of conservative treatment for patients ineligible for surgery for reasons such as advanced age and coexisting diseases. https://thejns.org/doi/10.3171/CASE24416.

Plasma vitamin D levels are correlated with the pathogenesis of human T-cell leukemia virus type 1-associated diseases.

The active form of vitamin D (VD) exerts hormonal effects by regulating the expression of genes involved in T-cell activity, cell differentiation, and proliferation. Human T-cell leukemia virus type 1 (HTLV-1) is a causative agent of life-threatening diseases, adult T-cell leukemia (ATL) and HTLV-1-associated myelopathy (HAM). Among ATL patients, hypercalcemia is one of the most serious complications due to bone resorption. In this study, wild-type mice administered UV-irradiated HTLV-1-infected cells showed up to 47% decrease of plasma VD level compared with untreated mice. To clarify the effect of HTLV-1 on plasma VD level, 315 samples registered in nationwide cohort study on ATL onset were measured. The VD level in HAM (14.98 ± 8.5 ng/mL) was significantly lower than those in asymptomatic carriers and ATL (p < 0.05). Upon comparing the VD levels in ATL stratified by disease subtypes, acute ATL showed a lower level (15.81 ± 12.0 ng/mL) than chronic and smoldering types (p < 0.05). In the longitudinal observation, VD levels were significantly higher in untreated spontaneous remission cases than in ATL progression cases, in which the VD levels decreased approximately 40% after onset. In cases of relapse after transplantation, the plasma VD level dropped to 38.7% of the pre-relapse level, while in cases of complete remission, the VD level increased with improvement of the performance status. Taken together, these results suggest that plasma VD level is a potential indicator for the onset and relapse of HTLV-1-associated diseases.

Antioxidant Defenses, Oxidative Stress Responses, and Apoptosis Modulation in Spontaneous Abortion: An Immunohistochemistry Analysis of First-Trimester Chorionic Villi.

Oxidative stress (OS) and apoptosis are critical factors in placental development and function. Their interplay influences trophoblast proliferation, differentiation, and invasion, as well as vascular development. An imbalance between these processes can lead to pregnancy-related disorders such as preeclampsia, intrauterine growth restriction, and even spontaneous abortion. Our study seeks to elucidate the associations between preventive antioxidant/protective OS response factors-glutathione (GSH), MutT Homolog 1 (MTH1), and apoptotic regulation modulators-tumor protein p53 and B-cell lymphoma (Bcl-2) transcripts, in the context of spontaneous abortion (30 samples) versus elective termination of pregnancy (20 samples), using immunohistochemistry (IHC) to determine their proteomic expression in chorionic villi within abortive fetal placenta tissue samples. Herein, comparative statistical analyses revealed that both OS response factors, GSH and MTH1, were significantly under-expressed in spontaneous abortion cases as compared to elective. Conversely, for apoptotic regulators, p53 expression was significantly higher in spontaneous abortion cases, whereas Bcl-2 expression was significantly lower in spontaneous abortion cases. These findings suggest that a strong pro-apoptotic signal is prevalent within spontaneous abortion samples, alongside reduced anti-apoptotic protection, depleted antioxidant defenses and compromised oxidative DNA damage prevention/repair, as compared to elective abortion controls. Herein, our hypothesis that OS and apoptosis are closely linked processes contributing to placental dysfunction and spontaneous abortion was thus seemingly corroborated. Our results further highlight the importance of maintaining redox homeostasis and apoptotic regulation for a successful pregnancy. Understanding the mechanisms underlying this interplay is essential for developing potential therapies to manage OS, promote placentation, and avoid unwanted apoptosis, ultimately improving pregnancy outcomes. Antioxidant supplementation, modulation of p53 activity, and the enhancement of DNA repair mechanisms may represent potential approaches to mitigate OS and apoptosis in the placenta. Further research is needed to explore these strategies and their efficacy in preventing spontaneous abortion.

Histopathological and Immunohistochemical Studies of a Spontaneous Case of Pulmonary Adenomatosis in an Adult Ram: A Case Report

Aim: The present study aimed to describe histopathological findings and immunohistochemical expression of proliferating cell nuclear antigen (PCNA) in a spontaneous case of pulmonary adenomatosis in an adult ram. Case Presentation: A carcass of an adult ram was presented for necropsy in the Post-mortem Hall of the Department of Veterinary Pathology, College of Veterinary Sciences of the Lala Lajpat Rai University of Veterinary and Animal Sciences, Hisar with a history of respiratory distress. A detailed necropsy was performed. The tracheal mucosa showed mild congestion. The lungs were pale and firm in consistency. On histopathological examination, nasal turbinate and trachea both showed the vascular changes along with mild infiltration of mononuclear cells. The sections of lungs revealed pulmonary adenocarcinoma characterized by the presence of cuboidal to low columnar epithelial cells forming acinar or papillary-like structures in the parenchyma and surrounded by the normal alveoli. Areas of necrosis along with infiltration of mononuclear cells were also evident. An Immunohistochemical study of the lung sections revealed mild to moderate immunopositive reactivity for the PCNA in the nuclei of neoplastic cells of adenocarcinoma. It indicated the proliferative activity of neoplastic cells. Conclusion: Based on histopathological examination, the present case was diagnosed as pulmonary adenomatosis. PCNA expression indicated the presence of actively proliferating neoplastic cells.

Antidepressant-associated diagnostic change from major depressive to bipolar disorder.

Anticipating diagnostic change from major depressive (MDD) to bipolar disorder (BD) can support better prognosis and treatment, especially of depression but is challenging and reported research results are inconsistent. We therefore assessed clinical characteristics associated with diagnostic change from MDD to BD with antidepressant treatments. We compared characteristics of 3212 initially MDD patients who became (hypo)manic during antidepressant treatment to those with stable MDD diagnoses as well as with cases of stable, spontaneous BD, using standard bivariate and multivariate statistics. Among MDD patients, 6.69% [CI: 5.85-7.61] changed to BD, mostly type II (BD2, 76.7%). BD-converters had higher rates of familial mood disorders (74.1% vs. 57.1%) or BD (33.7% vs. 21.0%) and 2.8-years younger onset than stable MDD patients. They also had more prior depressive recurrences/year, years-of-illness, mood-stabilizer treatment, divorces, fewer children, more suicide attempts and drug-abuse, and higher intake cyclothymia, YMRS and MDQ scores. Predictors independently associated with diagnostic conversion were: more familial BD, depressions/year, unemployment, cyclothymic temperament, suicidal ideation or acts, and fewer children. BD-converters vs. spontaneous BD cases had significantly more suicide attempts, BD2 diagnoses, and affected relatives. Converting to vs. spontaneous BD1 was associated with more ADHD, more suicidal ideation or behavior, MDI course, and younger onset; converting to vs. spontaneous BD2 had more episodes/year, unemployment, ADHD, substance abuse, suicidal ideation or attempts, and more relatives with BD. Few (6.69%) initially MDD subjects converted to BD, most (76.7%) to BD2. Independent predictive associations with diagnostic change included: familial BD, more depressions/year, unemployment, cyclothymic temperament, suicidal behavior and fewer children. Notably, several characteristics were stronger among those changing to BD during antidepressant treatment vs. others with spontaneous BD.

Acute atrazine intoxication in heifers: Case report and toxicological studies

AbstractAtrazine is a triazine organochloride herbicide, frequently used in different agricultural activities. Rare acute intoxication with atrazine is reported in production animals, and its metabolism in mammals is unknown. We report a spontaneous case of atrazine acute intoxication in 16.1% animals of a 168‐beef heifer herd exposed to the herbicide at a farm located in Buenos Aires province, Argentina. Affected heifers showed different neurological signs and died suddenly, similar to the previous natural atrazine intoxication report. During autopsy, no gross lesions were observed. Different body fluids and tissues samples were collected during postmortem examination. No relevant histopathological findings were observed. High levels of atrazine and its metabolites were detected in different fluids and tissues by ultra‐liquid chromatography high performance coupled to triple quadrupole mass spectrometry. These findings suggest ruminal or hepatic metabolization of atrazine in the exposed cattle. This is the first report of quantification and distribution of atrazine and its metabolites in intoxicated mammals providing relevant information for diagnostic purposes.

Epidural Blood Patch in Subdural Hematoma Due to Spontaneous Intracranial Hypotention: A Case Report and Literature Review

Spontaneous intracranial hypotension (SIH) is an orthostatic headache syndrome with variable symptoms and complications which is often misdiagnosed at initial manifestations. SIH results from spontaneous CSF leakage leading to brain sag. The typical findings on cranial MR imaging consist of subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain. Subdural hematoma may occur as a result of tearing of bridging veins and usually develop into chronic subdural hematoma. The majority of patients with SDH due to SIH have chronic DSH and, therefore, rarely present with neurological deficits. Evacuation of SDH may be performed for large SDH with ME (mass effects), or when dilated or asymmetric pupil is present. However in most cases, evacuation of the hematoma is not necessary and may result in worsened outcomes. The epidural blood patch (EBP) is a treatment of choice. Fortunately, most of these subdural hematomas can be handled with treatment directed at the underlying spinal CSF leak without the need for surgery. We report the case of 42-year-old man with the chief complaint of orthostatic headache. He was admitted to neurology ward and after imaging studies, it was found that he has bilateral subdural hematoma. Due to the lack of history of trauma, underlying disease, and coagulation disorder, and considering the imaging findings, the patient was referred to the pain department to perform an epidural blood patch. After performing the epidural blood patch, the patient's pain was relieved immediately, and during a three-month follow-up period, the epidural hematoma was completely absorbed. Spontaneous intracranial hypotension (SIH) is a highly misdiagnosed and underdiagnosed disorder and requires a high index of suspicion for diagnosis. During the last decades, a much larger number of spontaneous cases are identified. Literature is a bit confusing, with some authors recommending evacuation of subdural fluid in cases of deteriorating consciousness and few others recommending EBP first even in patients with comatose state but epidural patch is often an important part of treatment.

Acetazolamide-induced pulmonary oedema: A disproportionality analysis from the EudraVigilance database.

To our knowledge, no prior study has analysed a possible association between acetazolamide and pulmonary oedema. The aim of this study was to use data from the EudraVigilance to detect a safety signal for acetazolamide-induced pulmonary oedema. We performed a disproportionality analysis (case-noncase method), calculating reporting odds ratios (RORs) up to 22 February 2024. Among 11 684 208 spontaneous cases of adverse reactions registered in EudraVigilance, 38 275 were pulmonary oedemas. Acetazolamide was involved in 31 cases. In more than half of those cases, the patients received a single dose of acetazolamide after undergoing cataract surgery: latency was 10-90 min. Remarkably, there were five cases of positive rechallenge and six cases resulted in death. The ROR for acetazolamide was 3.63 (95% CI 2.55-5.17). Disproportionality was also observed in VigiBase®: ROR 4.44 (95% CI 3.34-5.90). Our study confirms a signal that suggests a risk of serious pulmonary oedema associated with acetazolamide.

Analysis of copy number variants detected by sequencing in spontaneous abortion.

The incidence of spontaneous abortion (SA), which affects approximately 15-20% of pregnancies, is the most common complication of early pregnancy. Pathogenic copy number variations (CNVs) are recognized as potential genetic causes of SA. However, CNVs of variants of uncertain significance (VOUS) have been identified in products of conceptions (POCs), and their correlation with SA remains uncertain. Of 189 spontaneous abortion cases, trisomy 16 was the most common numerical chromosome abnormality, followed by monosomy X. CNVs most often occurred on chromosomes 4 and 8. Gene Ontology and signaling pathway analysis revealed significant enrichment of genes related to nervous system development, transmembrane transport, cell adhesion, and structural components of chromatin. Furthermore, genes within the VOUS CNVs were screened by integrating human placental expression profiles, PhyloP scores, and Residual Variance Intolerance Score (RVIS) percentiles to identify potential candidate genes associated with spontaneous abortion. Fourteen potential candidate genes (LZTR1, TSHZ1, AMIGO2, H1-4, H2BC4, H2AC7, H3C8, H4C3, H3C6, PHKG2, PRR14, RNF40, SRCAP, ZNF629) were identified. Variations in LZTR1, TSHZ1, and H4C3 may contribute to embryonic lethality. CNV sequencing (CNV-seq) analysis is an effective technique for detecting chromosomal abnormalities in POCs and identifying potential candidate genes for SA.

Spondylodiscitis: Understanding pathophysiology, surgical strategies, and postoperative management - A single-center study.

Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center. A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P. Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases. Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.

Copy number variation sequencing for the products of conception: What is the optimal testing strategy

BackgroundCopy number variation sequencing (CNV-seq) is crucial in prenatal diagnosis, but its limitations in detecting polyploidy, maternal cell contamination (MCC), and uniparental disomy (UPD) restrict its application in the analysis of products of conception (POCs). This study aimed to investigate an optimal genetic testing strategy for POCs in the era of CNV-seq. MethodsCNV-seq and quantitative fluorescent polymerase chain reaction (QF-PCR) were performed in all 4,211 spontaneous miscarriage cases. Different testing strategies were compared and the optimal testing strategies were proposed. ResultsOf the 4,211 cases, 2561 (60.82%) exhibited clinically significant chromosomal abnormalities. CNV-seq alone, without QF-PCR, might misdiagnose 311 (7.39%) cases, including 278 polyploidy, 13 UPD, and 20 MCC. In 20 MCC cases identified by QF-PCR, CNV-seq successfully pinpointed the cause of miscarriage in 13 cases. Furthermore, in cases where QF-PCR suggested polyploidy, CNV-seq improved the diagnostic accuracy in 54 (1.28%) hypo/hypertriploidy cases. After comparing four different strategies, the sequential approach (initiating with CNV-seq followed by QF-PCR if necessary) emerged as advantageous, reducing approximately 70% of the cost associated with QF-PCR while maintaining result accuracy. ConclusionsWe propose an initial CNV-seq followed by QF-PCR if needed—an efficient and cost-effective strategy for the genetic analysis of POCs.

Serum Vitamin D3 level in spontaneous abortion cases in comparison to ongoing viable pregnancies: A case–control study in a tertiary medical college

Background: The immunoregulatory functions of Vitamin D3 play a vital role in the maintenance of normal pregnancy. Several studies have reported the association of low serum Vitamin D3 levels with spontaneous abortion. Aims and Objectives: The purpose of the study was to determine the association between serum Vitamin D3 level and spontaneous abortion cases in a tertiary medical college. Materials and Methods: The case–control study was conducted at the Department of Gynecology and Obstetrics, Medical College, Kolkata. The study population included 50 women with spontaneous abortion (cases) and 50 women with viable pregnancy beyond 20 weeks of gestation (controls). The cases and controls were matched with respect to age, socioeconomic status, and laboratory parameters. Investigations performed for both groups were ultrasonography for confirmation of abortion and viable pregnancy, serum Vitamin D3, and other biochemical markers. Data were compared between cases and controls using the Chi-square test and unpaired “t” test along with the calculation of odds ratios (OR). Results: About 24% of cases and 10% of controls belonged to Vitamin D3 deficient category. The difference was statistically significant (P=0.009, d.f.=2) (OR: 2.84, 95% confidence intervals [CI]: 0.92–8.80). Bleeding PV was present in 50% of cases and 4% of controls (P=0.0001, d.f.=1) (OR: 24.00, 95% CI: 5.25–109.65). Abdominal pain was complained by 46% of cases and 10% of controls (P=0.0001, d.f.=1) (OR: 7.67, 95% CI: 2.61–22.54). Conclusion: Vitamin D3 deficiency was present more in spontaneous abortion cases in comparison to viable pregnancies. Routine daily supplementation of vitamin D3 during the first trimester of pregnancy should be incorporated into the ongoing national program. Training of health workers to educate pregnant women and their family members regarding the importance of vitamin D3 is the need of the hour.

Analyses of tertiary lymphoid structures observed in cases of Merkel cell carcinoma showing spontaneous regression.

Merkel cell carcinoma (MCC) is a high-grade skin cancer, but spontaneous regression is observed at a markedly higher frequency than in other carcinomas. Although spontaneous regression is a phenomenon that greatly impacts treatment planning, we still cannot predict it. We previously reported on the prognostic impact of the presence or absence of tertiary lymphoid structures (TLS) and of Merkel cell polyomavirus (MCPyV) infection. To learn more about the spontaneous regression of MCC, detailed analyses were performed focusing on spontaneous regression cases. We collected 71 Japanese patients with MCC including 6 cases of spontaneous regression. Samples were analysed by immunostaining, spatial single-cell analysis using PhenoCycler, and RNA sequencing using the next-generation sequencer (NGS). All 6 cases of spontaneous regression were positive for MCPyV. TLS was positive in all 5 cases analysed. Spatial single-cell analyses revealed that PD-L1-positive tumour cells were in close proximity to CD20-positive B cell and CD3-, 4-positive T cells. Gene set enrichment analysis between MCPyV-positive and TLS-positive samples and other samples showed significantly high enrichment of "B-cell-mediated immunity" gene sets in the MCPyV-positive and TLS-positive groups. In conclusion, TLS may play an important role in the spontaneous regression of MCC.

The Impact of the COVID-19 Pandemic on the Incidence of Herpes Zoster: A Narrative Literature Review.

Coronavirus disease 2019 (COVID-19) has had a broad impact on health services and health outcomes. During the pandemic, there were numerous reports of herpes zoster (HZ) in people with COVID-19 and in COVID-19 vaccine recipients. The aim of this review is to elucidate the global effects of the COVID-19 pandemic on HZ. It is postulated that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection produces an immunosuppressive state that favours varicella zoster virus (VZV) reactivation. Three large cohort studies (a multinational study and studies from the USA and Spain) that excluded individuals vaccinated against HZ reported significantly increased risk of HZ following COVID-19 infection, especially in people aged ≥ 50years. In contrast, a large study from Israel that did not consider HZ vaccination status reported no such increase. Cases of HZ following COVID-19 vaccination have been reported and may be the result of attenuated cell-mediated immunity. This phenomenon appears to vary by vaccine type. Some (but not all) large analyses have reported a significant positive relationship between receipt of mRNA vaccines for COVID-19 and development of HZ. These include analyses of health records databases in Israel and Hong Kong and of spontaneous case reports in the US Vaccine Adverse Event Reporting System (VAERS) database. Routine vaccinations, including shingles vaccine programmes, were disrupted by the COVID-19 pandemic. It is estimated that missed shingles vaccinations may have resulted in 63,117 avoidable HZ cases in the USA. Now that the World Health Organization has declared an end to the COVID-19 pandemic as a health emergency and routine vaccination services have resumed, there is a need to increase awareness of HZ and HZ vaccination.Graphical abstract available for this article.

Spontaneous pneumomediastinum and tracheal injury: An extraordinary case report in an adult

Spontaneous pneumomediastinum (SPM) associated with subcutaneous emphysema and tracheal injury following persistent vomiting is rare. Here, we report a case of a young adult who presented to the emergency and trauma department with severe vomiting and abdominal pain, persisting for four days, and denied any symptoms of respiratory distress. Physical examination revealed mild dehydration and abdominal tenderness. A chest X-ray indicated subcutaneous emphysema and pneumomediastinum. A subsequent computed tomography (CT) scan confirmed a tracheal tear, pneumomediastinum, and emphysema. The patient received conservative management, including fluids, adequate analgesia, and antibiotics. Spontaneous cases are often linked to forceful coughing. Diagnosis primarily relies on imaging, mainly CT scans, while bronchoscopy aids in assessing tracheal tears. Treatment typically involves conservative measures like observation, pain management, and antibiotics. The patient was managed conservatively with antibiotics and supportive care in this case. SPM with stable conditions typically respond favorably to conservative treatment, and complete resolution can be anticipated within two days to one week.

Endovascular Embolization of Spontaneously Ruptured Renal Artery Pseudoaneurysm in a Post-Partum Woman: A Case Report

Renal artery pseudoaneurysm (RAP) is a rare but potentially life-threatening condition that is often challenging to diagnose. While commonly associated with procedures or trauma, spontaneous cases are exceedingly rare. We present a case of a post-partum woman with a spontaneously ruptured segmental renal artery pseudoaneurysm. We report a 19-year-old post-partum woman presented with an enlarged kidney and rising serum creatinine levels following a caesarean section. Imaging revealed a ruptured renal artery pseudoaneurysm, and endovascular glue embolization was performed successfully.

Spontaneous regression of cancer: a review of cases reported in Indian literature

Spontaneous regression of tumors is an exceptional response in the absence of standard treatment for the disease. The associated mechanisms are not completely understood, however immune modulation has been indicated to be the most probable process for spontaneous regression. Summarizing and analyzing the available information of these cases may aid in developing effective and safe therapeutic modalities for cancer. This review investigates the spontaneous regression cases reported in India during the period of 1988 to 2022. We conducted an online search (Google and Pubmed) using the keywords “spontaneous regression, cancer, India” for reports from India. All reports in the relevant literature were investigated for the criteria of spontaneous regression by Everson and Cole. 18 cases were defined as spontaneous regression and are reviewed in this article. The available information regarding patient demography, diagnosis, treatments and follow-up has been summarized. Squamous cell carcinoma is the most common type among 18 cases. 12 cases showed complete regression of tumor whereas 5 of them were partially regressed. Only 4 cases received chemotherapy and rest were not treated with any conventional anticancer treatment. An attempt has been made to delineate the mechanisms for SR proposed by the investigators. Acquiring data of more cases and more detailed information will definitely help us understand the mechanism of regression, providing an opportunity to improve cancer immunotherapy strategies.

Drug Exposure During Pregnancy: A Case-Control Study from a Primary Care Database.

Drug exposure during pregnancy is frequent, even more during first trimester as pregnant women might not be aware of their condition. We used available electronic health records (EHRs) to describe the use of medications during the first trimester in pregnant women and to compare drug exposure between those women who had an abortion (either elective or spontaneous) compared to those who had live births. Case-control study of abortions, either elective or spontaneous (cases), and live birth pregnancies (controls) in Sistema d'Informació per al Desenvolupament de la Investigació en Atenció Primària (Catalan Primary Health electronic health records) from 2012 to 2020. Exposure to drugs during first trimester of pregnancy was considered to estimate the association with abortion by conditional logistic regression and adjusted by health conditions and other drugs exposure. Sixty thousand three hundred fifty episodes of abortions were matched to 118,085 live birth pregnancy episodes. Cases had higher rates of alcohol intake (9.9% vs. 7.2%, p < 0.001), smoking (4.5% vs. 3.6%, p < 0.001), and previous abortions (9.9% vs. 7.8%, p < 0.001). Anxiety (30.3% and 25.1%, p < 0.001), respiratory diseases (10.6% and 9.2%, p < 0.001), and migraine (8.2% and 7.3%, p < 0.001), for cases and controls, respectively, were the most frequent baseline conditions. Cases had lower rate of drug exposure, 40,148 (66.5%) versus 80,449 (68.1%), p < 0.001. Association with abortion was found for systemic antihistamines (adjusted odds ratio [ORadj] 1.23, 95% confidence interval [CI] 1.19-1.27), antidepressants (ORadj 1.11, 95% CI 1.06-1.17), anxiolytics (ORadj 1.31, 95% CI 1.26-1.73), and nonsteroidal anti-inflammatory drugs (ORadj 1. 63, 95% CI 1.59-1.67). These high rates of drug exposures during the first trimester of pregnancy highlights the relevance of informed prescription to women with childbearing potential.

Successful Manitol Treatment in Young Man Patient with Spontaneous Operable Chronic Subdural Hematoma: A Case Report

Chronic subdural hematoma (cSDH) is a common neurosurgery disorder among the elderly, but it is rare in the younger patients. Incidence of cSDH is approximately 5/100.000 a year in the general population but it has higher rate in elderly. Most cases of cSDH has prior trauma event which then leads to hematoma formation in subdural space and inflammation is believed to have an important role in its pathophysiology. This study reports a spontaneous cSDH case in a young adult patient whose symptoms appeared to be chronic headache, nausea, vomiting and dizziness. Any neurological deficit was absent. This patient was treated conservatively using an osmotic agent, mannitol, despite the fact that the current patient had an indication of surgical treatment. The patient was discharged from the hospital with a good outcome. After 2 months of follow-up, there was no sign of recurrence. Our study found several considerations in deciding treatment options for cSDH, including the condition of the patient and the doctor in charge’s viewpoint.

Spontaneous Chronic Subdural Hematoma in Young Man Patient with Conservative Treatment : A Case Report

Background: Chronic subdural hematoma (cSDH) is a common neurosurgery disorder among the elderly, but it is rare in the younger patients. Incidence of cSDH is approximately 5/100.000 a year in the general population but it has higher rate in elderly. Most cases of cSDH has prior trauma event which then leads to hematoma formation in subdural space and inflammation is believed to have an important role in its pathophysiology.&#x0D; Case Report: This study reports a spontaneous cSDH case in a young adult patient whose symptoms appeared to be chronic headache, nausea, vomiting and dizziness. Any neurological deficit was absent. This patient was treated conservatively using an osmotic agent, mannitol, despite the fact that the current patient had an indication of surgical treatment. The patient was discharged from the hospital with a good outcome. After 2 months of follow-up, there was no sign of recurrence.&#x0D; Conclusion: Our study found several considerations in deciding treatment options for cSDH, including the condition of the patient and the doctor in charge’s viewpoint.