A closed internal degloving injury is a soft tissue injury, in which the subcutaneous tissue is ripped from the underlying fascia. In rare cases, a closed internal degloving injury can lead to hemorrhagic shock. A 79-year-old woman was brought to the emergency department following an auto-pedestrian accident, in which she was hit by a car. She was in a stupor and was hypotensive. The initial evaluation was unremarkable. During management, the patient required the transfusion of a large volume of blood, and vasoactive agent. Abdominal computed tomography revealed a large hematoma in her lower back and gluteal area and she was diagnosed with a closed internal degloving injury. Missed or delayed diagnosis of this type of injury may result in a significant increase in transfusion requirements and irreversible hemorrhagic shock.
Aged ; Contusions ; Delayed Diagnosis ; Emergency Service, Hospital ; Fascia ; Female ; Hematoma ; Humans ; Shock, Hemorrhagic ; Soft Tissue Injuries ; Stupor ; Subcutaneous Tissue

A 35-year-old female visited emergency department for a sudden onset of headache with vomiting after management for abortion at local department. Neurological examination revealed drowsy mentality without focal neurological deficits. CT showed 3.2×3.4 cm hyperdense intraventricular mass with intraventricular hemorrhage. The intraventricular hemorrhage was found in lateral, 3rd, and 4th ventricles. MRI showed well enhancing intraventricular mass abutting choroid plexus in the trigone of the right lateral ventricle. CT angiography showed tortuous prominent arteries from choroidal artery in tumor. Her neurological status deteriorated to stupor and contralateral hemiparesis during planned preoperative workup. Urgent transtemporal and transcortical approach with decompressive craniectomy for removal of intraventricular meningioma with hemorrhage was done. Grossly total removal of ventricular mass was achieved. Pathological finding was meningotheliomatous meningioma of World Health Organization (WHO) grade I. The patient recovered to alert mentality and no motor deficit after intensive care for increased intracranial pressure. However, visual field defect was developed due to posterior cerebral artery territory infarction. The visual deficit did not resolve during follow up period. Lateral ventricular meningioma with spontaneous intraventricular hemorrhage in pregnant woman is very uncommon. We report a surgical case of lateral ventricular meningioma with rapid neurological deterioration for intraventricular hemorrhage.
Adult ; Angiography ; Arteries ; Choroid ; Choroid Plexus ; Critical Care ; Decompressive Craniectomy ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Fourth Ventricle ; Headache ; Hemorrhage ; Humans ; Infarction ; Intracranial Pressure ; Lateral Ventricles ; Magnetic Resonance Imaging ; Meningioma ; Neurologic Examination ; Paresis ; Posterior Cerebral Artery ; Pregnancy ; Pregnant Women ; Stupor ; Visual Fields ; Vomiting ; World Health Organization

We present the case of a 71-year-old man who was diagnosed with amoebic encephalitis caused by Balamuthia mandrillaris. He had rheumatic arthritis for 30 years and had undergone continuous treatment with immunosuppressants. First, he complained of partial spasm from the left thigh to the left upper limb. Magnetic resonance imaging revealed multifocal enhancing nodules in the cortical and subcortical area of both cerebral hemispheres, which were suggestive of brain metastases. However, the patient developed fever with stuporous mentality and an open biopsy was performed immediately. Microscopically, numerous amoebic trophozoites, measuring 20 to 25 µm in size, with nuclei containing one to four nucleoli and some scattered cysts having a double-layered wall were noted in the background of hemorrhagic necrosis. Based on the microscopic findings, amoebic encephalitis caused by Balamuthia mandrillaris was diagnosed. The patient died on the 10th day after being admitted at the hospital. The diagnosis of amoebic encephalitis in the early stage is difficult for clinicians. Moreover, most cases undergo rapid deterioration, resulting in fatal consequences. In this report, we present the first case of B. mandrillaris amoebic encephalitis with fatal progression in a Korean patient.
Aged ; Balamuthia mandrillaris ; Biopsy ; Brain ; Cerebrum ; Diagnosis ; Encephalitis ; Fever ; Humans ; Immunosuppressive Agents ; Magnetic Resonance Imaging ; Necrosis ; Neoplasm Metastasis ; Rheumatic Fever ; Spasm ; Stupor ; Thigh ; Trophozoites ; Upper Extremity

Extrapontine myelinolysis is a demyelinating disorder usually caused by rapid correction of chronic hyponatremia. We present an 82-year-old female patient with general weakness, and severe hyponatremia (103 mEq/L) which was corrected 14 mEq/L during 21 hours. She was stuporous and presented status epilepticus. Brain T2-weighted image showed high signal intensities of bilateral thalami and electroencephalogram monitoring indicated right hemisphere lateralized periodic discharges, maximal in the right frontal region. This case shows that status epilepticus can occur in a patient of extrapontine myelinolysis involved bilateral thalami without pontine lesions.
Aged, 80 and over ; Brain ; Demyelinating Diseases ; Electroencephalography ; Female ; Humans ; Hyponatremia ; Myelinolysis, Central Pontine ; Status Epilepticus ; Stupor

Cerebral venous sinus thrombosis (CVST) is a rare disease. Early diagnosis and treatment are important, as CVST is potentially fatal. Pregnancy and puerperium are known risk factors for CVST. Here, we report the case of a patient who developed superior sagittal sinus thrombosis after a normal vaginal delivery. A 20-year-old woman presented with a headache and seizures two days after a normal vaginal delivery. Initially, brain computed tomography (CT) showed a subarachnoid hemorrhage in the right parietal lobe and sylvian fissure, together with mild cerebral edema. CT angiography revealed superior sagittal sinus thrombosis. Multiple micro-infarctions were seen on diffusion-weighted magnetic resonance images. An intravenous infusion of heparin and mannitol was administered immediately. Two days after treatment initiation, the patient showed sudden neurological deterioration, with left-sided hemiplegia. Brain CT showed moderate brain edema and hemorrhagic densities. Emergency decompressive craniectomy was performed, and heparin was re-administered on post-operative day (POD) 1. On POD 9, the patient's mental state improved from stupor to drowsy, but the left-sided hemiplegia persisted. CT angiography showed that the superior sinus thrombosis had decreased. Superior sagittal sinus thrombosis is an uncommon complication, with an unfavorable outcome, after delivery. Timely diagnosis and treatment are important for preventing neurological deterioration.
Angiography ; Brain ; Brain Edema ; Cerebral Infarction ; Decompressive Craniectomy ; Diagnosis ; Early Diagnosis ; Emergencies ; Female ; Headache ; Hemiplegia ; Heparin ; Humans ; Infusions, Intravenous ; Mannitol ; Parietal Lobe ; Postpartum Period* ; Pregnancy ; Rare Diseases ; Risk Factors ; Seizures ; Sinus Thrombosis, Intracranial ; Stupor ; Subarachnoid Hemorrhage ; Superior Sagittal Sinus* ; Thrombosis* ; Young Adult

We describe the case of a patient with an acute subdural hematoma (SDH) that was removed using urokinase irrigation after burr hole trephination in a limited situation where craniotomy was not possible. A 90-year-old woman was admitted to our hospital with a stuporous mental status. Computed tomography (CT) scans revealed a chronic SDH, and a burr hole procedure was performed. The patient's postoperative progression was good until the third day after surgery when we found that the acute SDH had increased on CT scans. The patient's guardian refused further surgery, and thus we drained the blood from the hematoma by injecting urokinase through a drainage catheter. We used urokinase for two days, and removed the catheter after confirming via CT scans that the hematoma was almost alleviated. The patient recovered gradually; she was discharged with few neurological deficits.
Aged, 80 and over ; Catheters ; Craniotomy ; Drainage* ; Female ; Hematoma ; Hematoma, Subdural, Acute* ; Humans ; Stupor ; Tomography, X-Ray Computed ; Trephining ; Urokinase-Type Plasminogen Activator*

A 15-year-old man presented with stupor following a motorcycle traffic accident. The patient was diagnosed with a traumatic left carotid cavernous fistula (CCF) with pseudoaneurysm of the left internal carotid artery. Brain magnetic resonance imaging (MRI) showed transiently restricted diffusion in the left centrum semiovale white matter and lower temporo-occipital area extending to the splenium of the corpus callosum, with high signal intensity on diffusion-weighted imaging. On the 35th day of admission, the patient had complete neurological recovery and a follow-up brain MRI revealed complete resolution of the lesions in the left centrum semiovale and splenium of the corpus callosum. These clinical and radiological features are highly suggestive of complete reversal of diffusion restriction after successful embolization of traumatic CCF.
Accidents, Traffic ; Adolescent ; Aneurysm, False ; Brain ; Carotid Artery, Internal ; Corpus Callosum ; Diffusion* ; Fistula* ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Motorcycles ; Stupor ; White Matter

Pneumocephalus is commonly seen after craniofacial injury. The pathogenesis of pneumocephalus has been debated as to whether it was caused by ball valve effect or combined episodic increased pressure within the nasopharynx on coughing. Discontinuous exchange of air and cerebrospinal fluid due to “inverted bottle” effect is assumed to be the cause of it. Delayed tension pneumocephalus is not common, but it requires an active management in order to prevent serious complication. We represent a clinical case of a 57-year-old male patient who fell down from 3 m height, complicated by tension pneumocephalus on 5 months after trauma. We recommend a surgical intervention, but the patient did not want that so we observe the patient. The patient was underwent seizure and meningitis after 7 months after trauma, he came on emergency room on stupor mentality. Tension pneumocephalus may result in a neurologic disturbance due to continued air entrainment and it significantly the likelihood of intracranial infection caused by continued open channel. Tension pneumocephalus threat a life, so need a neurosurgical emergency surgical intervention.
Cerebrospinal Fluid ; Cerebrospinal Fluid Leak ; Cough ; Craniocerebral Trauma ; Emergencies ; Emergency Service, Hospital ; Humans ; Male ; Meningitis ; Middle Aged ; Nasopharynx ; Pneumocephalus* ; Seizures ; Stupor

Cases of the cement ingestion are rare. This paper reports the successful management of cement ingestion with gastric lavage and endoscopic washing. A 69-year-old man who had a stuporous mentality and seizures visited the local emergency room. He was found in his room with cement powder and several liquor bottles. He underwent a gastric lavage in the prior emergency room, which showed evidence of cement ingestion. He was transferred to the emergency center after primary care. Cement mixed with water is a strong alkali and acts as a caustic agent in the gastrointestinal tract. In addition, it can become hard in a few hours and sometimes produce gastric bezoars. Generally, gastric lavage is not recommended for caustic agents. On the other hand, gastric lavage and endoscopic washing was performed repeatedly for successful removal despite the physical and chemical characteristics of cement. Therefore, the active removal of ingested cement by both gastric lavage and endoscopic washing is recommended.
Aged ; Alkalies ; Bezoars ; Eating* ; Emergencies ; Emergency Service, Hospital ; Endoscopy ; Gastric Lavage ; Gastrointestinal Tract ; Hand ; Humans ; Primary Health Care ; Seizures ; Stupor ; Water

Acute hemorrhagic leukoencephalitis (AHLE) is an acute, rapidly progressing, fulminant demyelinating disease. It is a rare disease of the central nervous system with high mortality; survivors commonly present with significant neurological deficit. We report the case of a 16-month-old girl who survived AHLE and presented with the associated neurologic deficit. The patient came into the emergency department with febrile seizure. She showed bilateral pinpoint-sized pupils and hyperactive deep tendon reflexes. Her mental status was initially drowsy and rapidly progressed to stupor. Extensive demyelination and microbleeds were found in the cerebral white matter, thalamus and left cerebellum on Magnetic resonance imaging (MRI) scans. Her mental status was improved by intravenous administration of immunoglobulin and methylprednisolone. Five months after being discharged, increased white matter connectivity was found on color-coded follow-up MR diffusion tensor imaging (DTI) as compared to previous MRI. We therefore suggest adding the DTI technique when a follow-up MRI is performed in patients with AHLE. It could be useful to visualize the status of axonal injury and to encourage patients and their parents to continue the rehabilitation program.
Administration, Intravenous ; Axons ; Central Nervous System ; Cerebellum ; Child ; Demyelinating Diseases ; Diffusion Tensor Imaging* ; Diffusion* ; Emergency Service, Hospital ; Female ; Follow-Up Studies* ; Humans ; Immunoglobulins ; Infant ; Leukoencephalitis, Acute Hemorrhagic* ; Magnetic Resonance Imaging ; Methylprednisolone ; Mortality ; Neurologic Manifestations ; Parents ; Pupil ; Rare Diseases ; Reflex, Stretch ; Rehabilitation ; Seizures ; Seizures, Febrile ; Stupor ; Survivors ; Thalamus ; White Matter