Don’t pin it all on a stereotype

Hypercalcemia is one of the most frequently encountered problems in endocrinology OPD. Although the evaluation may not always be straightforward in all scenarios. Common factors affecting calcium levels such as dehydration, improper sample collection, and vitamin D supplementation may mask a serious underlying disorder. Here, we discuss a case of an elderly female who had symptoms of myelopathy and hypercalcemia whose etiology was initially attributed to excessive sup

Endovascular management of dissecting posterior cerebral artery aneurysm associated with persistent hypoglossal artery: A case report / Tratamento endovascular do aneurisma dissecante da artéria cerebral posterior associado à artéria hipoglossa persistente: relato de caso

Abstract Persistent embryological connections between the anterior and posterior circulations are rare entities. Persistent hypoglossal artery is the second most common persistent carotid-basilar anastomosis. As it is often associated with hypoplasia of vertebral arteries, it poses a challenge during endovascular interventions. We present a case of a 32-year-old woman who presented with occipital headache of four weeks' duration. Magnetic Resonance Angiography showed hypoplastic vertebral arteries with a persistent hypoglossal artery arising from the cervical segment of the left internal carotid artery and supplying the entire posterior circulation, associated with a dissecting aneurysm of the right posterior cerebral artery. Endovascular parent vessel occlusion was performed for the dissecting posterior cerebral artery aneurysm by navigating the guide catheter, microwire, and microcatheter through the persistent hypoglossal artery because the vertebral arteries were hypoplastic. Post-intervention, the patient did not develop any neurological deficit and was discharged in a stable condition.

Resumo Conexões embriológicas persistentes entre as circulações anterior e posterior são entidades raras. A artéria hipoglossa persistente é a segunda anastomose carotídeo-basilar persistente mais comum. Como está frequentemente associada à hipoplasia das artérias vertebrais, apresenta um desafio durante as intervenções endovasculares. Apresentamos o caso de uma mulher de 32 anos que apresentou cefaleia occipital com duração de quatro semanas. A angiografia por ressonância magnética mostrou artérias vertebrais hipoplásicas com artéria hipoglossa persistente surgindo do segmento cervical da artéria carótida interna esquerda e suprindo toda a circulação posterior com um aneurisma dissecante da artéria cerebral posterior direita. A oclusão endovascular do vaso parental foi realizada para o aneurisma da dissecção da artéria cerebral posterior pela passagem de cateter guia, microfio e microcateter pela artéria hipoglossa persistente, pois as artérias vertebrais eram hipoplásicas. Após a intervenção, a paciente não apresentou déficit neurológico e recebeu alta em uma condição estável.

Atypical Presentation of Typical Carcinoid of Lung with Therapeutic Cryoextraction –A Case Report

Introduction: Leptospirosis is a widespread zoonosis causedby the spirochete leptospira. Epidemic leptospirosis is beingreported from Kerala during the monsoon. Its incidence hasincreased over the past two decades. Severe leptospirosisresults in sepsis with multi organ dysfunction syndrome andmortality rate varies from 5-40%. In this study we attemptedto identify the risk factors associated with mortality ofleptospirosis.Material and methods: This was a retrospective case-controlstudy among patients diagnosed with severe leptospirosisand admitted in a tertiary care hospital in Thrissur District ofKerala during the monsoon of 2014. Data was collected fromcase records of 48 patients out of which 21 were cases (nonsurvivors) and 27 were controls (survivors) and Statisticalanalysis was done using X2 test with Epi info software.Results: Mean age of study population was 42 yrs. There were38 male (79%) out of which 14 were cases and 10 females(21%) out of which 7 were cases. Mortality rate was 44%. 77%of them presented with myalgia. Among cases 62% had icterus,81% had oliguria, 66% underwent mechanical ventilationand 62% undergone blood and blood product transfusion.Dyspnoea (p=0.08), Chest crepitations (p=0.005), decreasedurine output(p=0.012), acute kidney injury(p=0.005), hepaticdysfunction(p=0.06), shock (p=0.019), haemoglobin less than10g% (p=0.03) and platelet count less than 20000(p=0.025)were found to have significant association with mortality.Conclusion: The severe disease is more common in middleaged males but mortality is more in female. Platelet countless than 20000 and shock were found to be the independentpredictors of mortality.

Central nervous system norcardiosis with granulomatous pachymeningitis and osteomyelitis of skull vault.

A 34-year-old immunocompetent man weighing 95 kg was operated for a small left parietal scalp swelling in the year 2002. He was well until 2008, when he developed chronic diffuse headache, vomiting and drowsiness. The left parietal dura and overlying vault biopsy showed evidence of granulomatous pachymeningitis with osteomyelitis secondary to nocardiosis. He had responded well to inadequate antibiotic therapy. After a dormant period of 3 years, there was recrudescence of severe raised intracranial tension symptoms in 2011. Magnetic resonance imaging showed diffuse pachymeningeal thickening mainly involving the occipital dura, posterior falx, and tentorium cerebelli. In addition, well-defi ned small nodules with hypointense signals on both T1- and T2-weighted images were seen in occipital lobes. Patient was treated with three drug regime with good recovery at 3 months follow-up. This is a rare case of central nervous system nocardiosis with skull vault osteomyelitis and a protracted clinical course.

Profile of compressive myelopathy as evaluated by magnetic resonance imaging.

To evaluate spectrum of diseases causing compressive myelopathy and accuracy of magnetic resonance imaging in diagnosing these conditions, a total of 69 clinically diagnosed cases of compressive myelopathy were evaluated by magnetic resonance imaging and results were tabulated. Caries spine was the commonest condition (24.6%) followed by metastasis spine (17.4%), ossified posterior longitudinal ligament (7.8%), primary bone tumours, nerve sheath tumours, intramedullary tumours and rare conditions like epidural abscess, spontaneous epidural haematoma, subdural haematoma, epidural lipomatosis, etc. Sensitivity, specificity and accuracy for diagnosing caries by magnetic resonance imaging was found to be 94%, 98% and 97% while that of metastasis spine was 91%, 98% and 97% respectively. Magnetic resonance imaging is the modality of choice for diagnosing compressive myelopathy.