Cauda equina syndrome (CES) is often defined as a complex of symptoms and signs consisting of low back pain, bilateral sciatica, lower extremity weakness, saddle anesthesia, and bowel and bladder dysfunction. CES is considered to be neurosurgical emergency. Delayed or missed diagnosis of CES can result in serious morbidity and neurological sequelae. However, the diagnosis of CES is often difficult when one or more of these symptoms are absent or when these symptoms develop asymmetrically or incompletely. We report a case of urinary retention and sphincter dysfunction without sciatica or motor weakness following an L3 burst fracture in a 52-year-old male and discuss the atypical presentation of CES and treatment of traumatic CES.
Anesthesia ; Cauda Equina* ; Diagnosis ; Emergencies ; Humans ; Low Back Pain ; Lower Extremity ; Lumbar Vertebrae ; Male ; Middle Aged ; Polyradiculopathy* ; Sciatica ; Spine* ; Urinary Bladder ; Urinary Retention

Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.
Abdomen ; Aged ; Brain Abscess ; Diabetes Mellitus ; Empyema, Subdural ; Enterococcus faecalis ; Epidural Abscess* ; Extremities ; Fatal Outcome ; Humans ; Male ; Pelvis ; Spine

No abstract available.
Humans ; Inpatients*

A congenital coronary artery fistula is a rare condition, which is an abnormal communication of the coronary artery with the ventricles or atriums or the pulmonary artery. A case of 69 year-old man, complaining of recent aggravating chest pain for 5 months is reported. The coronary angiography shows coronary artery-pulmonary artery fistula. Multidetector row CT shows coronary artery-pulmonary artery fistula combined with aortopulmonary fistula via common channel and the fistulas were surgically ligated.
Aged ; Arteries* ; Chest Pain ; Coronary Angiography* ; Coronary Vessels ; Fistula* ; Humans ; Pulmonary Artery

Idiopathic hypertrophic pachymeningitis (IHP) is a rare disease, and it is characterized by chronic progressive inflammatory fibrosis and thickening of the dura mater with resultant compression of the spinal cord or neural structure without any identifiable cause. It can occur in the intracranial or spinal dura mater alone or as a craniospinal form. The spinal form is rarer than the cranial form and the craniospinal form is extremely rare. We report a rare case of IHP in the craniocervical junction involving both the cranial and spinal dura mater and discuss the diagnosis and management of the disease.
Diagnosis ; Dura Mater ; Fibrosis ; Meningitis* ; Rare Diseases ; Spinal Cord

Langerhans cell histiocytosis (LCH) is related diseases characterized by proliferation of Langerhans cell with involvement of bone, skin, lung and other organs. LCH usually occurs in childhood and are presented as multiple small papules or eczematoid lesion mostly. We report a 50-year-old man with 3 brown lichenoid patches on left dorsal foot. He was diagnosed pulmonary LCH 5 years ago. Typical LC cells on skin lesion and CD1 complex positive staining confirm the diagnosis of LCH. We consider brown lichenoid patches may be a previously unreported cutaneous presentation in cutaneous or multisystem LCH.
Foot ; Histiocytosis, Langerhans-Cell ; Humans ; Lung ; Middle Aged ; Skin

BACKGROUND: Upper gastrointestinal endoscopy is a very important and highly sensitive method to detect gastroduodenal lesions. But the investigation and diagnosis of gastrointestinal diseases might be delayed by discomfort, pain and anxiety in patients during endoscopy. This study was performed to evaluate the effect of family member's attendance on relief of discomfort in patients and to identify the predictors for pain and discomfort during upper gastrointestinal endoscopy. METHODS: From July to August 2005, 147 clients who underwent gastrointestinal endoscopy were enrolled in this study. The subjects were randomly grouped into family-attended (n=70) group and non-family-attended group (n=77). The patients recorded their pain and discomfort during endoscopy by Visual-Analogue Scale (VAS) score. And also the client's demographic characteristics and endoscopy related factors (procedure duration, previous endoscopy experience, biopsy, endoscopist etc.) were evaluated. We studied the relationship between the various characteristics and discomfort during endoscopy. RESULTS: There were no significant differences of clients' demographic characteristics and endoscopy related factors between the two groups. There was a significant difference of VAS scores between the family-attended group (3.51+/-1.90) and non-family-attended group (4.35+/-2.10) (P= 0.012). Oxygen saturation and pulse rate during the procedure were lower in the family-attended group than in the non-attended group. Recipients' demographic characteristics and various factors related with the procedure (waiting time, biopsy, and previous experience, etc) were not associated with the degree of discomfort. CONCLUSION: Family member's attendance decreased pain and discomfort during endoscopy. The recipients' demographic characteristics and factors related to the procedure had no influence on the degree of discomfort during endoscopy. In conclusion, attendance of a family member should be considered during endoscopy in order to decrease pain and discomfort during the procedure.
Anxiety ; Biopsy ; Endoscopy ; Endoscopy, Gastrointestinal ; Gastrointestinal Diseases ; Heart Rate ; Humans ; Oxygen ; Pain Measurement

No abstract available.
Pneumocystis carinii* ; Pneumocystis* ; Pneumonia ; Pneumonia, Pneumocystis*

Leg swelling in patients with paraplegia due to spinal cord injury (SCI) occurs for various reasons, including heterotopic ossification (HO), deep vein thrombosis (DVT), fracture, or cellulitis. The clinical presentations of these conditions may overlap in part or in whole and it may occasionally be difficult to distinguish. Of these conditions, DVT and subsequent pulmonary embolism remain significant causes of morbidity and mortality in patients with SCI. Therefore, a prompt diagnostic work-up, particularly for DVT, is essential in patients with SCI, who present with leg swelling. Here, we report a case of leg swelling in a paraplegic patient, resulting from HO mimicking DVT and discuss the differential diagnosis.
Cellulitis ; Diagnosis, Differential ; Humans ; Leg* ; Mortality ; Ossification, Heterotopic* ; Paraplegia ; Pulmonary Embolism ; Spinal Cord Injuries ; Venous Thrombosis*

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococci (MRCNS) are major causes of neurosurgical infection. Nasal colonization of MRSA is the most important risk factor and MRSA screening can be a screening method to identify MRSA and MRCNS colonization. We retrospectively evaluated prophylactic effect of vancomycin on MRSA or MRCNS surgical site infection (SSI) after cranioplasty following decompressive craniectomy (DC) after traumatic brain injury (TBI) in MRSA carriers. METHODS: The study included 21 patients who were positive in MRSA screening before cranioplasty. These patients underwent DC after TBI and subsequent cranioplasty with autologous bone. The patients were separated into SSI group and no SSI group according to the development of SSI due to MRSA or MRCNS after cranioplasty. Mean follow-up period after cranioplasty was 23.5+/-22.8 months (range, 3 to 73 months). The rate of MRSA or MRCNS SSI and factors including the prophylactic preoperative antibiotics were compared between groups. RESULTS: The rate of MRSA or MRCNS SSI was 23.8% (5/21 patients). Mean time from cranioplasty to confirm the SSI was 19.6+/-10.9 days (6 to 63 days). The rate of MRSA or MRCNS SSI was significantly different from the use of preoperative prophylactic antibiotics (p=0.047). MRSA or MRCNS SSI developed in 1 of 13 patients (7.6%) who received vancomycin and in 4 of 8 patients (50%) who received 3rd generation cephalosporin. CONCLUSION: Preoperative MRSA screening and administration of vancomycin as a preoperative prophylactic antibiotic should be considered in MRSA carriers who are scheduled to cranioplasty to reduce MRSA or MRCNS SSI.
Anti-Bacterial Agents ; Brain Injuries* ; Coagulase ; Colon ; Decompressive Craniectomy ; Follow-Up Studies ; Humans ; Mass Screening ; Methicillin Resistance* ; Methicillin-Resistant Staphylococcus aureus* ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections ; Staphylococcus ; Surgical Wound Infection ; Vancomycin*