1/7. Haemorrhagic acoustic neuroma with features of a vascular malformation. A case report.A 55-year-old man with hearing loss presented with vertigo and vomiting. CT tomography and MRI demonstrated a cerebellopontine angle mass with foci of haemorrhage. An angiomatous tumour, with large abnormal veins adhering to the capsule, was completely removed. Histologically, the tumour was an acoustic neuroma with abnormal vascularisation and limited intratumoral haemorrhage.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/7. The role of the biochemistry department in the diagnosis of pituitary apoplexy.A 47-year-old man presented with severe clinical hypoglycaemia. He had long-standing insulin-dependent diabetes with previously good glycaemic control. Intense headaches and vomiting initiated hospitalization. A brain computed tomography (CT) scan was normal, and a lumbar puncture showed elevated cerebrospinal fluid (CSF) protein [0.67 g/L; normal range (NR) 0.15-0.45 g/L], suggesting resolving viral meningitis. Routine thyroid function tests were abnormal (free thyroxine 10.6 pmol/L, NR 9-22.5 pmol/L; thyroid-stimulating hormone 0.16 mU/L, NR 0.35-5 mU/L). In the absence of evident thyroid therapy, the laboratory policy required an urgent cortisol assay to be added; this was very abnormal (42 nmol/L), suggesting hypopituitarism. Later analysis showed that concentrations of gonadotrophins and adrenocorticotrophin were low. An urgent pituitary magnetic resonance imaging scan revealed an unsuspected pituitary tumour with recent haemorrhage (pituitary apoplexy). The patient was given intravenous hydrocortisone and then stabilized on oral hydrocortisone, thyroxine and mesterolone. He made a full recovery and the hypoglycaemia resolved. The normal brain CT scan was falsely reassuring and the CSF protein was not due to viral meningitis but to haemorrhage into the pituitary tumour. If laboratory policy had not required the urgent cortisol assay be added, the diagnosis of hypopituitarism would have been delayed or even missed altogether. This could have led to the death of the patient.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
3/7. Total iris expulsion through a sutureless cataract incision due to vomiting.PURPOSE: To present a case of isolated total iris expulsion through a self-sealing cataract incision 2 weeks postoperatively due to vomiting. methods: Ophthalmological examination included visual acuity assessment, tonometry, slit-lamp examination, fundus ophthalmoscopy and ultrasound examination. RESULTS: A 65-year-old woman experienced sudden visual loss during an episode of vigorous vomiting 2 weeks after uncomplicated phacoemulsification cataract surgery with a sutureless corneal incision. Clinical examination showed a dense anterior chamber haemorrhage. When the blood had cleared, isolated total aniridia was seen. CONCLUSIONS: This is the first reported case of aniridia after cataract surgery due to vomiting.- - - - - - - - - - ranking = 0.5keywords = haemorrhage (Clic here for more details about this article) |
4/7. Carboxyatractyloside poisoning in humans.OBJECTIVE: Cocklebur (xanthium strumarium) is an herbaceous annual plant with worldwide distribution. The seeds contain the glycoside carboxyatractyloside, which is highly toxic to animals. We describe nine cases of carboxyatractyloside poisoning in humans which, to our knowledge, has not previously been reported. The clinical, laboratory and histopathological findings and our therapeutic approach are also discussed. SUBJECTS AND methods: The patients presented with acute onset abdominal pain, nausea and vomiting, drowsiness, palpitations, sweating and dyspnoea. Three of them developed convulsions followed by loss of consciousness and death. RESULTS: Laboratory findings showed raised liver enzymes, indicating severe hepatocellular damage. BUN and creatinine levels were raised, especially in the fatal cases who also displayed findings of consumption coagulopathy. CPK-MB values indicative of myocardial injury were also raised, especially in the fatal cases. Three of the patients died within 48 hours of ingesting carboxyatractyloside. Post-mortem histopathology of the liver confirmed centrilobular hepatic necrosis and renal proximal tubular necrosis, secondary changes owing to increased permeability and microvascular haemorrhage in the cerebrum and cerebellum, and leucocytic infiltrates in the muscles and various organs including pancreas, lungs and myocardium. CONCLUSIONS: Carboxyatractyloside poisoning causes multiple organ dysfunction and can be fatal. Coagulation abnormalities, hyponatraemia, marked hypoglycaemia, icterus and hepatic and renal failure are signs of a poor prognosis. No antidote is available and supportive therapy is the mainstay of treatment.- - - - - - - - - - ranking = 0.5keywords = haemorrhage (Clic here for more details about this article) |
5/7. Sudden onset of vomiting as a presentation of perimesencephalic subarachnoid haemorrhage.Subarachnoid haemorrhage (SAH) makes up 1% of all attendances for acute severe headache to emergency departments, but other less common presentations may be seen. A 28-year-old man presented to the ED complaining of a 24-h history of nausea and vomiting of sudden onset, but without headache. The patient also described mild photophobia and neck stiffness. A computed tomography scan revealed perimesencephalic blood, and a subsequent angiogram was negative. This appearance is seen in cases of non-aneurysmal SAH, which often occur in younger, male, normotensive patients, and give rise to few warning symptoms. A high index of suspicion should be maintained for SAH, even in the absence of headache.- - - - - - - - - - ranking = 2.5keywords = haemorrhage (Clic here for more details about this article) |
6/7. Unusual cause of sudden onset headache: spontaneous intracranial hypotension.Spontaneous intracranial hypotension is a very distinctive but unusual cause of acute headache. The postural nature of the headache can be easily overlooked in the celerity to exclude subarachnoid haemorrhage. We describe the clinical and radiological features of a case that emphasizes some of the diagnostic difficulties. An approach to management and treatment for this condition is outlined.- - - - - - - - - - ranking = 0.5keywords = haemorrhage (Clic here for more details about this article) |
7/7. Intractable vomiting due to a brainstem lesion in the absence of neurological signs or raised intracranial pressure.The case of a 30 year old man who was believed to have a gastrointestinal motility disorder causing his chronic vomiting is reported. He had been well until 21 months previously when he had developed recurrent vomiting which would occur up to 10 times in a 24 hour period. vomiting was not precipitated by eating and was not associated with any other symptoms. He had lost 25 kg in weight. A psychiatric assessment did not reveal a psychogenic cause for his vomiting. A brainstem magnetic resonance imaging scan revealed an area of low signal in the low midbrain just above the pons to the left of the midline. After gadolinium contrast injection the area enhanced. There was little or no mass effect, that is minimal displacement of normal structures, and minimal oedema. The appearance was that of a low grade or early brainstem tumour. There were no features of haemorrhage or infarct. The patient was managed with oral dexamethasone, resulting in prompt resolution of his symptoms. A search for a central neurological cause is recommended in a patient with unexplained persistent vomiting, even in the absence of other features to suggest a neurological problem. Autonomic function testing may provide additional information.- - - - - - - - - - ranking = 0.5keywords = haemorrhage (Clic here for more details about this article) |