Cases reported "Hernia"

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1/5. Nerve root herniation secondary to lumbar puncture in the patient with lumbar canal stenosis. A case report.

    STUDY DESIGN: A very rare case of nerve root herniation secondary to lumbar puncture is reported. OBJECTIVE: To describe the characteristic clinical features of this case and to discuss a mechanism of the nerve root herniation. SUMMARY OF BACKGROUND DATA: There has been no previous report of nerve root herniation secondary to lumbar puncture. methods: A 66-year-old woman who experienced intermittent claudication as a result of sciatic pain on her right side was evaluated by radiography and magnetic resonance imaging, the results of which demonstrated central-type canal stenosis at L4-L5. The right sciatic pain was exacerbated after lumbar puncture. myelography and subsequent computed tomography showed marked stenosis of the thecal sac that was eccentric to the left, unlike the previous magnetic resonance imaging finding. RESULTS: At surgery, a herniated nerve root was found through a small rent of the dorsocentral portion of the thecal sac at L4-L5, presenting a loop with epineural bleeding. The herniated nerve root was put back into the intrathecal space, and the dural tear was repaired. CONCLUSION: Lumbar puncture can be a cause of nerve root herniation in cases of lumbar canal stenosis. The puncture should not be carried out at an area of stenosis.
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2/5. Fatal tonsillar herniation in pseudotumor cerebri.

    A 27-year-old woman with pseudotumor cerebri died after lumbar puncture secondary to tonsillar herniation. Five years earlier she had a respiratory arrest after lumbar puncture. MRI and autopsy ruled out the presence of an arnold-chiari malformation or a mass lesion of the posterior fossa, but midsagittal views suggested the presence of low-lying cerebellar tonsils.
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3/5. Colloid cyst of the 3rd ventricle as a cause of acute neurological deterioration and sudden death.

    A 13 year old girl presented with a 24 h history of headache and vomiting. There were no focal neurological signs. The diagnoses considered were vascular headache, meningitis and subarachnoid haemorrhage. Lumbar puncture revealed clear cerebrospinal fluid under high pressure and subsequent cerebral computed tomography (CT) scan revealed hydrocephalus. death occurred some hours after the lumbar puncture. autopsy revealed a colloid cyst of the 3rd ventricle causing the hydrocephalus. Cerebellar tonsillar herniation was present. This case is reported because although 3rd ventricular colloid cysts are a recognized cause of acute neurological deterioration and sudden death, they rarely present in childhood. In this case, it is considered that lumbar puncture may have hastened death by increasing brain-stem compression due to cerebellar tonsillar herniation. It raises the question of whether cerebral CT scan, where readily available, should be performed prior to lumbar puncture. Pathologically, colloid cysts may be easily missed if the brain is examined fresh as the cysts are fragile and have a tendency to be destroyed or fall out.
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4/5. Omental herniation through a 5-mm laparoscopic cannula site.

    Herniation is a rare complication of laparoscopy, and has not previously been reported to occur through a 5-mm puncture site. A patient experienced an incarcerated omental prolapse through an incision for a 5-mm cannula 4 days after undergoing a laparoscopic radical hysterectomy. Based on our experience, we recommend fascial closure of all laparoscopic cannula insertion sites if possible, and emphasize the need for evaluating omental or enteric protrusions through even small fascial defects.
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5/5. Painful piezogenic pedal papules: response to local electro-acupuncture.

    We report the case of a woman who had pain in both heels which was exacerbated by long periods of exercise. On examination, there were small flesh-coloured papules which appeared over the medial and lateral aspects of the heels only on weight bearing. Coincidentally, she was noted to have larger flesh-coloured papules over the anterior surface of the shins. The diagnoses of painful piezogenic pedal papules and bilateral tibialis anterior muscle herniation, respectively, were made. After many attempts to control the pain, a course of electro-acupuncture was commenced. A good subjective clinical response was achieved which has been maintained by fortnightly treatments. We discuss the prevalence, pathogenesis and treatment of painful piezogenic pedal papules. We believe that our patient is the first to have 'herniations' at both heel and shin sites and the first to have successful sustained pain relief for painful piezogenic pedal papules.
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