Application of Hong’s technique for removal of stuck hemodialysis tunneled catheter to pacemaker leads

The term “stuck catheter” refers to situations where a central venous catheter cannot be removed from the central veins or right atrium using standard technique, usually due to development of a fibrin sheath leading to adherence to SVC or right atrial wall. Endoluminal dilatation is an interventional radiology technique that has been previously reported in the removal of stuck hemodialysis catheters, and to the best of our knowledge, this case describes the first application of the technique to remove a hemodialysis catheter that was adherent to SVC wall and transvenous pacemaker leads

Multiple sclerosis relapse presenting as trigeminal neuralgia

I present here a case of trigeminal neuralgia (TGN), which is a highly disabling disorder characterized by brief and recurrent shock-like episodes of facial pain. TGN occurs in 2% of people with MS. A 54-year-old woman diagnosed with multiple sclerosis (MS) in 2008 and who was in remission stopped taking her disease-modifying therapy (DMT) in 2018 due to a lack of relapses presented to our facility with excruciating right facial pain. Magnetic resonance imaging (MRI) of the brain with gadolinium showed enhancing plaque involving the proximal cisternal portion of the right trigeminal nerve on axial and sagittal sections. She was started on carbamazepine 300 mg 4 times a day. This case highlights the need for early diagnosis by MRI with gadolinium enhancement and prompt initiation of treatment helped her pain to subside and was able to return a week later to the MS clinic to be restarted on her prior DMT to prevent further MS relapses

Patient with basilar artery occlusion related to metastatic melanoma

Posterior circulation stroke accounts for approximately 20% of all ischemic strokes. The basilar artery, which is the main vessel of the posterior circulation, supplies most of the brainstem, occipital lobes and part of the cerebellum and thalami. We present a case of a 73-year-old man with known metastatic melanoma while undergoing immunotherapy presented to the emergency department with a history of progressive shortness of breath, generalize weakness, and dysphagia. The patient's imaging workup revealed brain metastasis. While hospitalized had a sudden onset of loss of consciousness which lasted a few minutes and was back to baseline. An hour later he had another episode of loss of consciousness with absence of brainstem signs. Urgent head computerized tomography showed basilar artery occlusion. Patient was transferred to the intensive care unit and started on intravenous heparin (DVT/PE dosing protocol) and supportive care. At present there is lack of high-quality evidence from randomized controlled trial to guide as how best manage patients with basilar artery occlusion

Superior bearing dislocation in a unicompartmental total knee prosthesis

The mobile bearing Oxford Unicompartmental Knee Prosthesis (OUKP) is the most commonly used treatment of osteoarthritis confined to 1 compartment of the knee. Dislocation of the mobile bearing is an uncommon but recognized complication of the OUKP. Patients typically present with severe pain and reduced range of motion of the affected knee. Radiological evaluation of OUKP can be challenging and requires knowledge of the prosthesis components and common complication patterns. Dislocation of the bearing can easily be overlooked on plain radiographs as the bearing is radiolucent, distinguished only by radiopaque markers. Further imaging in particular with CT may be required to adequately evaluate for prosthesis complications. Advances in prosthesis design and surgical technique may reduce the rate of bearing dislocation. Keywords: Unicompartmental knee replacement, Dislocation, Prosthetic, Radiograp