Dislodged Levornogestrel-intrauterine system intra-abdominally without uterine perforation: is it possible?

We report a case of dislodged Levornogestrel-intrauterine system (LNG-IUS, Mirena®) without evidence of uterine perforation. A 37-year-old Para 4+1presented with 3 months history of lower abdominal pain. Examination and imaging showed that the device was not present in the uterine cavity. She underwent laparoscopic retrieval of Mirena®. There was no evidence of uterine perforation intra-operatively. This case illustrated the rare possibility of dislodged Mirena®intra-abdominally without evidence of uterine perforation. The management for missing IUS was reviewed

Labrune’s Syndrome Presenting With Stereotypy-Like Movements and Psychosis : A Case Report and Review

Labrune’s syndrome, or leukoencephalopathy with brain calcifications and cysts (LCC), is a rare genetic syndrome with variable neurological presentations. Psychiatric manifestations and involuntary movements are uncommonly reported. We report the case of a 19-year-old female, initially diagnosed with Fahr’s syndrome, who presented to us with acute psychosis, abnormal behavior and involuntary movements. Her brain computed tomography showed extensive bilateral intracranial calcifications without cysts. Genetic testing detected two compound heterozygous variants, NR_033294.1 n.*9C>T and n.24C>T, in the SNORD118 gene, confirming the diagnosis of LCC. We discuss the expanding phenotypic spectrum of LCC and provide a literature review on the current diagnosis and management of this rare syndrome

Central nervous system intravascular lymphoma in a Malaysian.

Intravascular lymphoma (IVL) is a rare subtype of extranodal diffuse large cell lymphoma, characterized by intravascular proliferation of B or T lymphocytes within small blood vessels; which may lead to occlusive symptoms, its neurological involvement has been said to be uncommon among Asians. 1 We describe a Malaysian with central nervous system IVL, to demonstrate that IVL is an important differential diagnosis in diffuse brain pathology also among Asians

Tumor shrinkage in a tamoxifen-treated non-functioning pituitary neuroendocrine tumor with positive estrogen receptor-beta (ERβ): a case report and review of the literature

Administration of selective estrogen receptor modulators (SERMs) and anti-estrogens has been shown to reduce the size of pituitary tumors. However, previous studies were performed on animal pituitary tumors or tissue cultures. We administered oral tamoxifen to a postoperative patient with a nonfunctioning pituitary neuroendocrine tumor (NF-PitNET) to investigate its potential effect on tumor volume. This case report presents the case of a 47-year-old female patient with a null cell adenoma who had undergone surgical resection as primary treatment and was left with a residual tumor that grew significantly. She was treated with tamoxifen 20–40 mg daily for one year. She was followed up to assess tamoxifen adherence, tolerability, and adverse events. The resected pituitary tumor was stained with estrogen receptor alpha (ERα) and beta (ERβ), proliferation markers (ki-67 and p53), and H&E staining for mitotic count. MRI of the pituitary gland was performed before starting treatment, after 6 months, and after 1 year of tamoxifen therapy. Her resected tumor showed high-intensity ERβ staining in the absence of ERα expression. She was able to tolerate oral tamoxifen therapy without side effects. Tamoxifen therapy resulted in a remarkable reduction in residual tumor volume of up to 87 % in this patient. Tamoxifen has a potential therapeutic effect in treating patients with residual NF-PitNET tumors that have regrown after primary resection. This finding may provide an alternative treatment modality for recurrent NFPitNET. ERβ expression may predict response to tamoxifen in this subset of patients

Pituitary apoplexy: a rare cause of middle cerebral artery infarction

Pituitary apoplexy is a well-known complication of a pituitary adenoma. However, an ischaemic event caused by pituitary apoplexy is rare. We reported a case of pituitary apoplexy with middle cerebral artery infarction in a 44-year old man who presented with a sudden onset of altered sensorium. Vasospasm is the most likely underlying cause of the infarction in this case secondary to transdiaphragmatic rupture of the sella tumour into the subarachnoid space

Non-contrast computed tomography in acute ischaemic stroke: a pictorial review

Non-contrast computed tomography (NCCT) remains a widely used imaging technique and plays an important role in the evaluation of patients with acute ischaemic stroke. However,the task ofidentifying the signs of acute ischaemia and quantifying areas of brain involvement on NCCT scan is not easy due to its subtle findings. The reliability of arly ischemic sign detection can be improved with experience, clinical history and the use of stroke window width and level on viewing the images. The Alberta Stroke Program Early CT Score (ASPECTS) was developed to overcome the difficulty of volume estimation in patients eligible for thrombolysis. It is a systematic, robust and practical method that can standardized the detection and reporting of the extent of acute ischaemic stroke. This article serves as an educational material that illustrates those findings which are important for all clinicians involved in acute stroke car

A case of biopsy proven Acute Semyelinating Encephalomyelitis (ADEM) with Haemorrhagic Leucoencephalitis

Dear Editor, Acute disseminated encephalomyelitis (ADEM) is an immune-mediated infl ammatory disorder of the central nervous system. It has a monophasic course which occurs after viral infection or vaccination.1,2Acute haemorrhagic leucoencephalitis (AHLE) is considered to be a hyperacute form of ADEM which is fulminant and is frequently fatal.3 There are only a few cases of biopsy-proven AHLE in the current literature. This case emphasises the importance of early recognition by magnetic resonance imaging (MRI) for institution of medical therapy