1/392. Thoracic disc herniation mimicking acute lumbar disc disease.STUDY DESIGN: Case report of a 49-year-old woman with a lower thoracic disc herniation mimicking acute lumbosacral radiculopathy. OBJECTIVE: To describe an unusual case of thoracic disc herniation mimicking acute lumbar disc disease. SUMMARY OF BACKGROUND DATA: Symptomatic thoracic disc herniation is rare and its clinical manifestations differ widely from those of cervical and lumbar disc herniations. Midline back pain and signs of spinal cord compression progressing over months or years are the predominant clinical features. Acute and subacute thoracic disc herniation occurs in less than 10% of patients, and isolated root pain is unusual. methods: A 49-year-old woman had acute low back pain radiation into the left buttock and the lateral aspect of the left leg and left foot. magnetic resonance imaging study showed a bulging disc and posterior osteophytes at T11-T12. RESULTS: Surgical removal of the herniated disc and osteophytes rapidly relieved her symptoms and neurologic deficits. A follow-up neurologic examination 3 years later showed normal motor and sensory functions, although low back soreness was noted occasionally. CONCLUSION: A case of thoracic disc herniation mimicking an acute lumbosacral radiculopathy is presented. Compression of the lumbosacral spinal nerve roots at the lower thoracic level after exit from the lumbar enlargement may be the mechanism for this unusual presentation.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
2/392. Sight-threatening acute orbital swelling from peribulbar local anesthesia.Severe allergic reactions to peribulbar local anesthesia are extremely rare. A 70-year-old woman presented with acute orbital swelling and optic nerve dysfunction after a peribulbar local anesthetic injection. The patient was treated with acute orbital decompression as well as intravenous antibiotics and methylprednisolone; she made a good recovery. An allergy, probably to lignocaine, was the most likely cause. Urgent recognition and treatment of this condition may prevent potentially serious visual consequences.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
3/392. Atrial tamponade causing acute ischemic hepatic injury after cardiac surgery.A patient developed late cardiac tamponade after aortic valve replacement and coronary artery bypass grafting. nausea and dramatic elevations of serum aminotransferases were the initial clinical manifestations of cardiac tamponade. Severe acute ischemic hepatic injury secondary to isolated compression of both atrial cavities by two loculated thrombi was diagnosed.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
4/392. Successful treatment of traumatic acute posterior fossa subdural hematoma: report of two cases.BACKGROUND: Acute traumatic subdural hematoma of the posterior cranial fossa after a closed-head injury, excluding those in newborns, is a very rare clinical event. Generally, the outcome is poor and the overall mortality rate is high. methods: Acute posttraumatic subdural hematomas of the posterior fossa associated with acute hydrocephalus in two patients were removed by standard suboccipital approach. Preoperatively, one patient was in a coma and the Glasgow coma Score was 9 in another. CT scans showed obliterated mesencephalic cisterns in both cases. In the former there was a complex posterior fossa lesion, i.e., combined subdural and intracerebellar hematoma. The surgical decompression was completed 3 and 11 hours after injury, respectively. Intraoperative tapping of the lateral ventricle through a burr hole in the occipital area was performed in the latter case. RESULTS: Both patients survived; one made a good recovery, (i.e., glasgow outcome scale 4 in a patient who was comatose on admission), the other did not do as well (GOS 3). CONCLUSIONS: Our experience justifies the policy of mandatory early operation in cases of traumatic acute subdural hematoma of the posterior fossa associated with poor neurologic condition, even in patients of advanced age. In patients with obliterated mesencephalic cisterns and/or complex posterior fossa lesions the same approach must be followed. These clinical and CT features are not necessarily predictors of a poor outcome.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
5/392. Radicular acute pain after epidural anaesthesia with the technique of loss of resistance with normal saline solution.Epidural anaesthesia using the loss of resistance to saline technique, without air, was successfully performed in a 65-year-old man scheduled for elective vascular surgery of the right leg. Epidural catheterisation was uneventful. Fifteen minutes after the initial dose of plain 0.5% bupivacaine, the patient experienced severe pain in his lower abdomen and legs which coincided with a supplementary injection of 2 ml bupivacaine and 50 microgram fentanyl, and a change from the lateral to the supine position. General anaesthesia was induced and CT and MRI scans were performed showing trapped air in the epidural space at the L4 level causing compression of the thecal sac. After excluding other causes, the spontaneous entry of air through the Tuohy needle was thought to be the most likely explanation for this complication. The patient recovered uneventfully.- - - - - - - - - - ranking = 1keywords = compression (Clic here for more details about this article) |
6/392. Acute pulmonary edema associated with placement of waist-high, custom-fit compression stockings.Compression stockings are a safe, noninvasive treatment for patients with symptomatic orthostatic hypotension due to autonomic nervous system dysfunction. In this report, we describe a 75-year-old man who had development of pulmonary edema approximately 45 minutes after placement of compression stockings on the first postoperative day following a carotid endarterectomy. No sudden changes were noted on an electrocardiogram or echocardiogram or in the cardiac isoenzymes associated with the pulmonary edema. The patient had a history of coronary artery disease, diabetes mellitus-induced autonomic nervous system dysfunction, and recent surgery near the carotid baroreceptor. All these factors may have limited his ability to compensate for a rapid increase in central blood volume. The temporal relationship of the patient's respiratory distress to the placement of the compression stockings, in the absence of laboratory findings of primary cardiac dysfunction, make stocking-related fluid shift the likely precipitating event in the formation of acute pulmonary edema. This case suggests that compression stockings should be used with caution in patients with limited cardiac reserve.- - - - - - - - - - ranking = 7keywords = compression (Clic here for more details about this article) |
7/392. Acute orbital compartment syndrome after lateral blow-out fracture effectively relieved by lateral cantholysis.PURPOSE: To report the observation of an acute traumatic orbital compartment syndrome in an 80-year-old man. methods: Lateral canthotomy and cantholysis. Computed x-ray tomography. RESULTS: Unilateral proptosis, blindness, a frozen globe and a dilated pupil developed within one hour after a blunt trauma to the left orbital region. Surgery two hours later resulted in normal orbital tension and near-complete recovery of functions. An orbital hematoma was found overlying a lateral blow-out fracture. CONCLUSION: Under favorable conditions, the orbital compartment syndrome can be effectively relieved by lateral canthotomy and cantholysis. The present and previous reports suggest that two hours of orbital ischemia is near the critical time limit for recovery of full visual function.- - - - - - - - - - ranking = 3.591898388161keywords = fracture (Clic here for more details about this article) |
8/392. Suck and spit, don't blow: orbital emphysema after decompression surgery.PURPOSE: To describe the occurrence of vision-threatening orbital emphysema in patients awakening from orbital decompression surgery and to assess risk factors and preventive measures. DESIGN: Small noncomparative case series. PARTICIPANTS: Three patients undergoing bilateral orbital two-wall decompression experienced significant orbital emphysema associated with persistent coughing and Valsalva at the time of extubation. INTERVENTION: In two patients, symptoms resolved with simple observation, whereas one patient required sedation, topical anesthesia around the endotracheal tube, and needle decompression of trapped air. MAIN OUTCOME MEASURES: visual acuity, pupils, visual fields, and sensorimotor examination. RESULTS: No patient experienced a permanent deficit of visual or sensorimotor function. CONCLUSIONS: Acute orbital emphysema can occur after orbital decompression surgery despite the large bony opening created. Violent coughing spells at the time of extubation are more common in patients with a history of heavy tobacco use and may be causative. Opening the periorbita may be another specific predisposing risk factor. knowledge of this dangerous phenomenon, along with appropriate perioperative management, may prevent this complication from occurring.- - - - - - - - - - ranking = 8keywords = compression (Clic here for more details about this article) |
9/392. Acute spinal cord compression due to intraspinal bleeding from a vertebral hemangioma: two case-reports.Vertebral hemangiomas can cause acute spinal cord compression either after a minor trauma or during the last 3 months of pregnancy. Failure to recognize the lesion can lead to potentially serious treatment delays. An emergency MRI scan usually establishes the diagnosis of vertebral hemangioma responsible for spinal cord compression requiring laminectomy. We report two cases showing that posterior fixation should be considered: in our experience it prevents vertebral collapse during the interval preceding secondary vertebroplasty, which, if performed, provides highly significant pain relief.- - - - - - - - - - ranking = 6keywords = compression (Clic here for more details about this article) |
10/392. Acute traumatic dissection and blunt rupture of the thoracic descending aorta: A case report.Rupture of the thoracic aorta following blunt trauma is increasing in incidence and remains a highly lethal injury. Blunt traumatic rupture and acute dissection of the thoracic aorta is very rare. A 50-year-old man involved in a motor vehicle accident on March 3, 1998 was admitted to our hospital one and a half hours following the accident. On admission, he was alert and his hemodynamics were stable. Chest roentgenogram demonstrated a widened mediastinum and multiple left-sided rib fractures. Enhanced chest CT revealed a periaortic hematoma just distal to the isthmus, dissection of the descending thoracic aorta and mediastinal hematoma. With the diagnosis of thoracic aortic rupture and acute DeBakey type IIIB dissection, an emergency operation was performed. Intraoperative transesophageal echocardiogram showed a mobile intimal flap and diminished caliber of the proximal descending aorta. Disruption and dissection of the descending thoracic aorta were found. Prosthetic graft interposition was accomplished with the aid of left atrium-left femoral artery bypass using a centrifugal pump and heparin-coated circuits and a blood collection device for blood conservation. The weak dissected aortic wall was glued and reapproximated with Gelatine-Resorcine-Formol glue. The postoperative course was uneventful.- - - - - - - - - - ranking = 0.7183796776322keywords = fracture (Clic here for more details about this article) |
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