Upside down words as initial clinical presentation of an underlying acute ischemic stroke

@#We report a diabetic patient who was diagnosed with an acute stroke who presented with a 3-day history of difficulty of reading, described as the words were turned upside down, as if the words were inverted horizontally with associated right homonymous hemianopia and multiple higher cortical function deficits (alexia without agraphia, achromatopsia, prosopagnosia). He has poorly controlled diabetes and hypertension. Cranial magnetic resonance imaging (MRI) revealed an acute infarct on the left posterior cerebral artery territory. The patient was managed as an acute ischemic stroke and follow up after 6 months revealed improvement of the visual field cut but with persistence of the higher cortical function deficits. To the best of our knowledge, we report the first rare occurrence reversal of vision metamorphopsia described as inverted words as the sole initial presentation of an underlying stroke.

Congenital penile epidermal cyst: a rare location

A 22 years old male presented with a mass over the penis since birth, which was painless and gradually increasing in size. The mass was excised and it was found to be penile epidermal cyst. Epidermal cyst is one of the most common benign tumors occurring in the body, which commonly occurs either congenitally or following trauma or surgery, where the epidermal elements get trapped within closed space. But here this case had no trauma and surgeries in the past and the mass present since birth-a case of congenital penile epidermal cyst.

Intramedullary Dermoid Cyst of the Cervical Spinal Cord ­ C5­C7 Level

Introduction: Inclusion cysts of the spinal cord are rarely intramedullary. Such cysts are commonly located in the lumbar and thoracic regions and are usually associated with congenital spinal dysraphism and dermal sinus. Intramedullary dermoid cysts in the cervical region without spinal dysraphism are extremely rare. To our knowledge, only seven such cases are reported in the literature to date. Materials and Methods: An 18-year-old female patient presented with weakness in all four limbs, more distal than proximal muscle weakness, that had been progressing for 3 years. The magnetic resonance imaging (MRI) showed an intramedullary lesion from C5­ C7 with peripheral ring enhancement. "Whorls" were observed within the lesion on T2 weighted image, with associated excavation of vertebral bodies C5­ C7. Operative procedure and findings: partial laminectomy of C5­ D1was performed. The dura was opened. A small myelotomy was made in the root entry zone. About 1.5 ml of yellowish colored fluid was drained. White shiny debris with hair, whitish pultaceous content and teeth were removed. Complete excision of cyst and its wall was performed. Results The histopathological examination revealed that the cyst wall was lined by stratified squamous epithelium with underlying dermis showing hair follicles, sebaceous glands, adipose tissue and cyst filled with keratin debris suggestive of dermoid cyst. Conclusion: The intramedullary location of the dermoid cyst in the cervical cord and the absence of any congenital spinal dysraphism make this case a very unique and rare entity and warrants its inclusion in the reported cases of rare intramedullary space occupying lesions.

Introdução: Cistos de inclusão da medula espinhal raramente são intramedulares. Tais cistos são comumente localizados nas regiões lombares e torácicas e geralmente estão associados com disrafismo espinhal congênito e sinus dérmico. Cistos dermoides intramedulares na região cervical sem a presença de disrafismo espinhal são extremamente raros. Apenas sete casos foram relatados na literatura até a data do presente estudo. Materiais e Métodos: Uma paciente de 18 anos de idade apresentou fraqueza nos quatro membros, mais distal que proximal, com três anos progressivos de duração. A ressonância magnética apresentou uma lesão intramedular de C5 a C7 com realce do anel periférico. Espirais foram observadas dentro da lesão na imagem ponderada em T2, com escavação dos corpos vertebrais C5­C7. Procedimentos operatórios e achados: realização de laminectomia parcial de C5 a D1. A dura cervical foi aberta. Uma pequena mielotomia foi feita na zona de entrada da raiz. Cerca de 1,5 ml de fluído amarelado foi extraído. Detritos brancos brilhantes com cabelo, polpa esbranquiçada e dentes foram removidos. Foi realizada a excisão completa do cisto com parede de cisto. Resultados O exame histopatológico revelou que a parede do cisto estava alinhada por epitélio escamoso estratificado com derme subjacente apresentando folículos capilares, glândulas sebáceas, tecido adiposo e cisto cheio de detritos de creatinina, sugerindo cisto dermoide. Conclusão: A posição intramedular do cisto dermoide no cordão cervical e a ausência de disrafismo espinhal congênito faz deste um caso único, uma entidade rara, e assegura sua inclusão junto aos casos relatados de lesões raras ocupando espaço intramedulares.

Multıple Myeloma wıth Homogenous Secretıon of Lambda Lıght Chaın Immunoglobulın: A Case Report.

About 20% of people with multiple myeloma (MM) produce only light kappa chains which is produced in 80% of cases. This population of MM patients may be missed where the laboratory could not effectively detect free light chains of immunoglobulins as it is the case in most developing countries. Many reports showed that individuals with lambda light chain disease have a three times worse prognosis than kappa light chain disease. It is therefore important to improve awareness on the need to look out for light chain disease and emphasize the usefulness of a well-equipped laboratory that will fully analyze immunoglobulins of suspected multiple myeloma cases. After reviewing the patient, main findings included paraplegia, constipation and incessant vomiting suggestive of amyloidosis, a positive urinary bence jones proteins (BJP), normal biochemical parameters, elevated lambda light chain level and reversed kappa/lambda ratio of <0.01, magnetic resonance immaging (MRI) proven osteolytic lesions restricted to the spine and histology of bone marrow sample from laminectomy, as well as bone marrow aspiration cytology showed abnormal plasmacytosis. This is an unusual and rare presentation of MM in this environment. Free light chain (FLC) identification and quantitation should be carried out in all cases of suspected MM; especially in those with no monoclonal bands on serum protein electrophoresis and or immunofixation.