Irrigation for cerumen removal causing meningitis – case report

Introduction: Cerumen impaction is a common problem seen in primary care clinics. There are a variety of methods to deal with impacted cerumen including water irrigation but meningitis after water irrigation cerumen removal has not been previously reported. Methods: We describe the case of a 59-year-old female with otitis media who developed meningitis with empyema after water-jet irrigation for impacted cerumen. Results: Our patient presented 24-hours after water-jet irrigation for impacted cerumen with worsening headaches. Workup included positive CSF cultures and empyema on MRI consistent with meningitis. She also had ear drainage from the treated ear which was positive for multiple organisms. Neurologically she deteriorated in the short term but began to improve with intensive intravenous treatment. She was treated with six months of intravenous antibiotics and transitioned to further treatment with oral antibiotics as her laboratory testing and imaging improved. She showed ultimate resolution of labs, imaging and neurologic findings, returning to baseline. Conclusion: We report the first case to our knowledge of meningitis after water-jet irrigation for impacted cerumen. We recommend care when treating impacted cerumen in patients with underlying otitis media as there may be a risk for meningitis in certain circumstances

Introducer-free MIS-assisted Ventriculoperitoneal Shunt Placement: A Technical Document

Background The placement of the distal catheter of a ventriculoperitoneal shunt (VPS) can be challenging in patients with a large body habitus. Given the complications associated with ventriculoperitoneal shunts and known infection risk of obese patients, new techniques for VPS placement that bypass the abdominal fat must be sought. By avoiding the abdominal fat, decreased complications and infection risk may be possible. Objective The objective of this technical document is to describe a laparoscopic approach to the abdominal cavity during ventriculoperitoneal shunt surgery that makes use of a direct tunneling technique into the peritoneal space. Methods We perform a ventriculoperitoneal shunt placement with distal catheter implantation under laparoscopic guidance. Tunneling of the distal abdominal catheter was done through the abdominal fascia directly, without creation of a stab incision for the insertion site. Intraoperative video media was obtained using video footage from OPTIVIEW camera. Results We have found this technique to be feasible and useful for patients with large body habitus. By eliminating the incision overlying the catheter there is decreased risk for infection by skin flora and overall decreased risk of complications. Conclusion Our technique of tunneling directly into the abdominal cavity is both novel and feasible. To our knowledge this is the first time this technique has been described. We believe that further study of this technique in a case series may highlight its advantages in a certain subpopulation of patients requiring VPS

Cerebral Venous Sinus Thrombosis (CVST): Long-Term Single-Center Experience

CVST is a rare location of thrombosis involving Dural/ cerebral venous sinuses. It affects around 5-10 people per million population annually. It is an uncommon but life-threatening form of stroke affecting younger individuals. Therefore, identifying and treating in a timely manner is critical. Rarer thrombotic disorders like paroxysmal nocturnal hemoglobinuria (PNH) or Janus Kinase 2 (JAK2) mutation positive myeloproliferative neoplasms (MPN) can rarely present with CVST. It can also present during pregnancy for the first time. Diagnosis is often established by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). Infections, certain medication use (asparaginase or birth control pills) could lead to CVST. Patients often present with headaches, seizures or neurological deficits. Management is often with systemic anticoagulation despite intraparenchymal hemorrhage. Reducing intracranial pressure by invasive approaches is sometimes needed.https://digitalcommons.unmc.edu/surp2022/1024/thumbnail.jp

Safety and Efficacy of Riluzole in Traumatic Spinal Cord Injury: A Systematic Review With Meta-Analyses

Traumatic spinal cord injury (SCI) is a cause of significant morbidity, often resulting in long-term disability. We aimed to compare outcomes after riluzole versus patients who received placebo or standard of care with no specific intervention. MEDLINE, Embase, Scopus, and Cochrane Library database searches yielded 92 records, and five met the study inclusion criteria. Fixed-effect and random-effects models were used to establish odds ratios (ORs) and mean difference (MD) with 95% confidence intervals (CIs) for each outcome. The results of the pooled analysis showed that in patients with acute traumatic SCI, riluzole resulted in increased American Spinal Injury Association (ASIA) motor scores at 3 months (MD 0.26, 95% CI [?0.10,0.61], I2?=?0%; p?=?0.157) and 6 months (MD 0.21, 95% CI [?0.17,0.60], I2?=?0%; p?=?0.280) and change in ASIA Impairment Scale (AIS) at 3 months (OR 0.59, 95% CI [?0.12,1.30], I2?=?0%, p?=?0.101) and 6 months (OR 0.28, 95% CI [?0.50,1.06], I2?=?0%, p?=?0.479) in comparison to the control groups, though not to a level of statistical significance. Riluzole resulted in fewer adverse events than the control groups (OR ?0.12, 95% CI [?1.59,1.35], I2?=?0%, p?=?0.874) and lower mortality (OR ?0.20, 95% CI [?1.03,0.63], I2?=?0%, p?=?0.640), though also not to a level of statistical significance. These meta-analyses suggest that riluzole for the treatment of traumatic SCI is safe and results in improved neurological outcomes when compared to controls, though not to a level of statistical significance. More robust prospective, randomized studies are necessary to help inform the safety and efficacy of riluzole for traumatic SCI

Aneurysmal subarachnoid hemorrhage in patients taking direct oral anticoagulants: A case series and discussion of management

Direct oral anticoagulants are becoming more commonplace for the treatment of nonvalvular atrial fibrillation and deep vein thrombosis. Unfortunately, effective reversal agents are not widely available limiting options for neurosurgical intervention during active anticoagulation. We report a case series of 3 patients treated for aneurysmal subarachnoid hemorrhage while taking direct oral anticoagulants. All three underwent open surgical clipping after adequate time was allowed for drug metabolism. Decision-making must take into account timing of intervention, drug half-life, and currently available reversal agents. Keywords: Aneurysmal subarachnoid hemorrhage, Direct oral anticoagulant, Prothrombin complex concentrat