Homonymous hemianopsia as the leading symptom of a tumor like demyelinating lesion: A case report

Introduction: Differential diagnosis of a cerebral lesion can prove to be a very challenging task for the treating physician. Many non-neoplastic neurological diseases can mimic brain neoplasms on neuroimaging. Case presentation: A previously healthy 23-year-old male, presented with blurred vision to the Emergency Department of our Hospital. After initial clinical and serological examination, he was admitted to our clinic for further investigation. Neurological examination showed left homonymous hemianopsia. Brain MRI revealed edema of the right parietal lobe, compressing the posterior region of the right ventricle. Serum viral, immunological and paraneoplasmatic testing were negative. Spectroscopic MRI described the lesions as tumefactive demyelinated plaques. After treating the patient with intravenous corticosteroids, his symptoms rapidly improved and the extensive lesion of the parietal lobe decreased. Conclusion: In case of young patients with tumor-like lesions, demyelination should always be considered in the differential diagnosis. © 2009 Evangelopoulos et al; licensee BioMed Central Ltd

Pulsed corticosteroid treatment in MS patients stabilizes disease activity following natalizumab withdrawal prior to switching to fingolimod

Purpose: Interruption of natalizumab (NTM) treatment in multiple sclerosis (MS) patients may be followed by disease reactivation. On the other hand, patients with positive John Cunningham virus (JCV) antibodies treated with NTM over 24 months demonstrate a higher risk for developing progressive multifocal encephalopathy (PML). No established therapeutic approach is available for treating these patients to prevent disease reactivation. Materials and methods: Of the MS patients treated with NTM at the authors’ institution, 30 were found positive for JCV abs. NTM was interrupted followed by a washout period of 6 months. During this period, 20/30 patients received monthly intravenous (i.v.) methylprednisolone (MPD) 1000 mg infusion and regular clinical assessment. On months 3 and 6, brain MRI was performed and 1000 mg MPD was administered for 5 days. Results: All patients were clinically and radiologically stable at the time of NTM break. No clinical relapse was observed during the six-month washout period for the MS patients under monthly MPD treatment, while one patient had a relapse and active lesions in the MRI on month 6. Of the other patients not receiving i.v. MPD regularly after NTM withdrawal, one showed several active lesions in brain MRI and the other had a severe relapse. Conclusions: Despite the limited size of this patients’ cohort, the results of this study support that monthly MPD treatment for 6 months may result in a clinically stable disease status, thus ensuring safe transition to another second-line therapy such as fingolimod, following NTM withdrawal. © 2015 Informa UK Limited, trading as Taylor & Francis Group

A popliteal aneurysm with upper thigh extension: A tip of the iceberg finding

A 75-year-old male patient was referred to our orthopaedic department due to progressive weakening of the left leg, noticed while going up and down stairs, and swelling of the thigh. An increase in swelling was noted in association with spicy food. Clinical examination showed a palm-sized non-pulsatile soft mass in the popliteal region and swelling in the posterior-lateral thigh. MRI revealed a space-occupying 40×15×10 cm mass extending into the upper thigh without infiltrating character. Angiography was negative. Open surgical biopsy was performed to rule out a soft tissue tumour, during which, connection to the popliteal artery was identified. The patient underwent excision of the aneurismal sac and a prosthetic graft was interplaced. On follow-up, the patient noticed a rapid increase in muscle strength; stairs were no longer a problem

Author Correction: Methylprednisolone stimulated gene expression (GILZ, MCL-1) and basal cortisol levels in multiple sclerosis patients in relapse are associated with clinical response (Scientific Reports, (2021), 11, 1, (19462), 10.1038/s41598-021-98868-y)

The original version of this Article contained an error in the order of the References 16 and 17, which was incorrectly given as: 16. Hoepner, R. et al. Vitamin D increases glucocorticoid efficacy via inhibition of mTORC1 in experimental models of multiple sclerosis. Acta Neuropathol. https:// doi. org/ 10. 1007/ s00401- 019- 02018-8 (2019). 17. Ayroldi E, Riccardi C. Glucocorticoid‐induced leucine zipper (GILZ): a new important mediator of glucocorticoid action. FASEB J 23, 3649–3658 (2009). The correct order of the References is listed below: 16. Ayroldi E, Riccardi C. Glucocorticoid‐induced leucine zipper (GILZ): a new important mediator of glucocorticoid action. FASEB J 23, 3649–3658 (2009). 17. Hoepner, R. et al. Vitamin D increases glucocorticoid efficacy via inhibition of mTORC1 in experimental models of multiple sclerosis. Acta Neuropathol. https:// doi. org/ 10. 1007/ s00401- 019- 02018-8 (2019). The original Article has been corrected. © 2021, The Author(s)

Kidney infarction in Friedreich's ataxia with dilated cardiomyopathy

A 37-year-old man with advanced Friedreich's ataxia was referred to our emergency department with acute exacerbated abdominal pain of unclear aetiology. Laboratory tests showed slightly increased inflammatory parameters, elevated troponin and B-type natriuretic peptide, as well as minimal proteinuria. Transthoracic echocardiography revealed a pre-existing dilated cardiomyopathy. Abdominal sonography showed no pathological alterations. Owing to persistent pain under analgesia, a contrast-enhanced CT-abdomen was performed, which revealed a non-homogeneous perfusion deficit of the right kidney, although neither abdominal vascular alteration, cardiac thrombus, deep vein thrombosis nor a patent foramen ovale could be detected. Taking all clinical and radiological results into consideration, the current incident was diagnosed as a thromboembolic kidney infarction. As a consequence, lifelong oral anticoagulation was initiated. Copyright 2012 BMJ Publishing Group. All rights reserved

High energy tibial plateau fractures treated with hybrid external fixation

Management of high energy intra-articular fractures of the proximal tibia, associated with marked soft-tissue trauma, can be challenging, requiring the combination of accurate reduction and minimal invasive techniques. The purpose of this study was to evaluate whether minimal intervention and hybrid external fixation of such fractures using the Orthofix system provide an acceptable treatment outcome with less complications. Between 2002 and 2006, 33 patients with a median ISS of 14.3 were admitted to our hospital, a level I trauma centre, with a bicondylar tibial plateau fracture. Five of them sustained an open fracture. All patients were treated with a hybrid external fixator. In 19 of them, minimal open reduction and stabilization, by means of cannulated screws, was performed. Mean follow-up was 27 months (range 24 to 36 months). Radiographic evidence of union was observed at 3.4 months (range 3 to 7 months). Time for union was different in patients with closed and grade I open fractures compared to patients with grade II and III open fractures. One non-union (septic) was observed (3.0%), requiring revision surgery. Pin track infection was observed in 3 patients (9.1%). Compared to previously reported series of conventional open reduction and internal fixation, hybrid external fixation with or without open reduction and minimal internal fixation with the Orthofix system, was associated with satisfactory clinical and radiographic results and limited complications. © 2011 Babis et al; licensee BioMed Central Ltd

Effect of vertebroplasty on the compressive strength of vertebral bodies

Background context Percutaneous vertebroplasty has been used successfully for many years in the treatment of painful compressive vertebral fractures due to osteoporosis. Purpose To compare the effect of vertebroplasty on the compressive strength of unfractured vertebral bodies. Study design Biomechanical study on cadaveric thoracic vertebrae. Methods Forty vertebral bodies from four cadaveric thoracic spines were used for this experiment. Before testing, each thoracic spine was submitted to bone density testing and radiographic evaluation to rule out any obvious fractures. Under image intensification, 6 mL of a mixture of polymethylmethacrylate (PMMA) with barium (8 g of barium/40 g of PMMA) was injected into every other vertebral body of each spine specimen. After vertebroplasty, all soft tissues were dissected from the spine, and the vertebral bodies were separated and potted for mechanical testing. Testing to failure was performed using a combination of axial compression and anterior flexion moments. Two pneumatic cylinders applied anterior and posterior loads at a distance ratio of 4:3 relative to the anterior vertebral body wall, whereas two additional cylinders applied lateral loads, each at a constant rate of 200 N/s. Results The average failure loads for nonvertebroplasty specimens was 6724.02±3291.70 N, whereas the specimens injected with PMMA failed at an average compressive force of 5770.50±2133.72 N. No statistically significant difference in failure loads could be detected between intact specimens and those that had undergone vertebroplasty. Conclusions Under these specific loading conditions, no significant increase in compressive strength of the vertebral bodies could be documented. This suggests that some caution should be applied to the concept of "prophylactic" vertebroplasty in patients at risk for fracture