Adult ; Antipsychotic Agents ; therapeutic use ; Diagnosis, Differential ; Humans ; Insulin-Like Growth Factor I ; biosynthesis ; Magnetic Resonance Imaging ; methods ; Male ; Mental Status Schedule ; Pituitary Neoplasms ; complications ; diagnosis ; Prolactinoma ; complications ; diagnosis ; Psychotic Disorders ; complications ; diagnosis

Objective: The objective is to present a rare case of sub-acute form of Marchiafava-Bignami disease presenting with psychosis, minimal cognitive impairment and no clinical neurological signs. Methods: This is a case report of a patient with Marchiafava-Bignami disease presenting to a tertiary care psychiatric hospital in Singapore. A review of the literature of the condition is also presented. Results: The patient presented with prominent psychotic symptoms in the context of chronic alcohol abuse. He also had minimal cognitive impairment and clinically no neurological signs. A working diagnosis of alcohol induced psychotic disorder was made. His psychotic symptoms seemed to be resistant to treatment with antipsychotic medications initially and this led to further investigation by MRI scan of brain which revealed atrophy of corpus callosum and no other significant abnormalities. His psychotic symptoms gradually improved with treatment. He is now placed in an intermediate care setting in the hospital while waiting for a suitable community placement. Conclusions: It is rare for Marchiafava-Bignami disease to present with prominent psychotic symptoms with minimal cognitive impairment and no neurological signs clinically. In patients with a history of chronic alcohol abuse presenting with psychotic disorder, Marchiafava-Bignami disease should be suspected as a diagnostic possibility.

Hypoxic-ischemic brain injury encompasses a complex constellation of pathophysiological and cellular brain injury induced by hypoxia, ischemia, cytotoxicity, or combinations of these mechanisms and can result in poor outcomes including significant changes in personality and cognitive impairments in memory, cognition, and attention. We report a case of a male patient with normal premorbid functioning who developed prolonged delirium following hypoxic-ischemic brain insults subsequent to cardiac arrest. The case highlights the importance of adopting a multidisciplinary treatment approach involving the coordinated care of medical and nursing teams to optimise management of patients suffering from such a debilitating organic brain syndrome.
Anoxia ; Brain ; Brain Injuries ; Cognition ; Delirium ; Heart Arrest ; Humans ; Hypoxia-Ischemia, Brain ; Ischemia ; Male ; Memory ; Neurologic Manifestations ; Stress, Psychological

We present a case of delirium tremens lasting for five weeks in an alcohol-dependent individual. The patient required high-dose benzodiazepines, which is atypical and rare. The clinical presentation and management of this patient is discussed.
Adult ; Alcohol Withdrawal Delirium ; diagnosis ; drug therapy ; psychology ; Anti-Anxiety Agents ; therapeutic use ; Diagnosis, Differential ; Diazepam ; therapeutic use ; Humans ; Liver Cirrhosis ; diagnosis ; Male ; Mental Status Schedule

Methods: Obese patients (body mass index [BMI] ≥30.0 kg/m2) who underwent single-level MIS TLIF or ALIF at L5/S1 were included in the study. Demographic/perioperative variables, presenting patient pathology, and 1-year arthrodesis statistics were collected. PROM scores for Visual Analog Scale (VAS) back/leg, Oswestry Disability Index, 12-item Short Form Physical Composite Scale, and Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF) were collected from preoperative and postoperative (6 weeks, 12 weeks, 6 months, 1 year, 2 years) PROMIS-PF. The obese patients were classified based on the procedure they underwent (MIS TLIF vs. ALIF). Results: The criteria were met by 210 patients in total. After coarsened exact matching for Charlson comorbidity index score, degenerative spondylolisthesis, isthmic spondylolisthesis, degenerative scoliosis, foraminal stenosis, insurance, male, and ethnicity, 94 obese patients were included in the total cohort, with 59 receiving MIS TLIF and 35 receiving ALIF. ALIF recipients had higher PROMIS-PF scores at 6 weeks (p=0.014) and 12 weeks (p=0.030), as well as a higher VAS leg at 2 years (p=0.017). Following multiple regression accounting for differences in baseline BMI, only the 6-week PROMIS-PF significantly differed (p=0.028), with no other intergroup differences in mean PROMs between fusion types. Aside from a significantly higher 6-week MCID achievement rate for PROMIS-PF among ALIF recipients (p=0.006), no differences in attainment were observed. Conclusions There were no statistically significant differences in perioperative characteristics, fusion rates, PROMs, or MCID achievement between obese patients receiving MIS TLIF vs. ALIF. As a result, our findings indicate that MIS TLIF and ALIF at L5/S1 are equally effective in an obese patient population.

Methods: WC recipients undergoing single-level MIS TLIF were identified. PROMs of Visual Analog Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), 12-item Short Form Physical and Mental Composite Scale (SF-12 PCS/MCS), and Patient-Reported Outcomes Measurement Information System Physical Function evaluated subjects preoperatively/postoperatively. Subjects were grouped according to preoperative SF-12 MCS: <41 vs. ≥41. Demographic/perioperative variables, PROMs, and MCID were compared using inferential statistics. Multiple regression was used to account for differences in spinal pathology. Results: The SF-12 MCS <41 and SF-12 MCS ≥41 groups included 48 and 45 patients, respectively. Significant differences in ΔPROMs were observed at SF-12 MCS at all timepoints, except at 6 months (p≤0.041, all). The SF-12 MCS <41 group had worse preoperative to 6-months SF-12 MCS, 12-weeks/6-months VAS back, 12-week VAS leg, and preoperative to 6-months ODI (p≤0.029, all). The SF-12 MCS <41 group had greater MCID achievement for overall ODI and 6-weeks/1-year/overall SF-12 MCS (p≤0.043, all); the SF-12 MCS ≥41 group had greater attainment for 6-month VAS back (p=0.004). Conclusions Poorer mental functioning adversely affected the baseline and intermediate postoperative quality-of-life outcomes pertaining to mental health, back pain, and disability among WC recipients undergoing lumbar fusion. However, outcomes did not differ 1–2 years after surgery. While MCID achievement for pain and physical function was largely unaffected by preoperative mental health score, WC recipients with poorer baseline mental health demonstrated higher rates of overall clinically meaningful improvements for disability and mental health