Silicone allergy mimicking shunt infection.

PURPOSE: The purpose of this case report is to highlight silicone allergy as a rare cause of ventriculo-peritoneal shunt complication, often mimicking infection. MATERIALS AND METHODS: Information regarding the patient presented was obtained by review of their medical notes, both paper and electronically. A literature review was performed by searching Pubmed using the following terms; silicone allergy and shunt allergy, to identify similar publications. RESULTS: Nine publications between 1994 and 2019 formed the basis of the literature review. The primary aim was to identify clinical presentations that may help to identify silicone allergy as the cause of shunt complication. CONCLUSION: Silicone allergy is a rare cause of ventriculo-peritoneal (V-P) shunt failure and can mimic infection. This diagnosis should be consideredwith a predominantly lymphocytic CSF leucocytosis and no bacteriological evidence of a responsible organism, a peripheral eosinophilia and an intense fibrosis around a recently placed V-P shunt, as described in this case report.

Radiological investigations in non-aneurysmal subarachnoid haemorrhage: A 5-year review.

•All patients with a Fisher grade 2 bleed and a negative CT angiogram had catheter angiography negative for any abnormality.•Neuroradiologists identified vascular abnormalities not reported by district general hospitals.•Follow-up MRI may be a useful adjunct in subarachnoid haemorrhage.

Treatment of acute aneurysmal subarachnoid haemorrhage with primary flow diversion: 5-year single-centre experience.

AIM: To evaluate the safety and efficacy of treatment of patients presenting with acute aneurysmal subarachnoid haemorrhage (SAH) with primary flow-diverting stents (FDS; with or without adjuncts), with comparison to the published literature. MATERIALS AND METHODS: A retrospective single-centre review was undertaken of prospectively obtained data on patients treated for SAH over a 60-month period. Of 354 patients treated for SAH during that time period, 24 patients with a total of 25 aneurysms were identified. Baseline patient demographics were recorded and clinical and imaging outcomes assessed. RESULTS: Eighty-eight per cent (22/25) of the aneurysms were completely occluded (Raymond-Roy 1) at mean 12-month follow-up. The minor complication rate was 12.5% (3/24) without permanent morbidity. Mortality rate was 4% (1/25) after one patient died following aneurysmal rebleed on day 7 post-procedure. Forty-two per cent (10/24) of patients had a high-pressure shunt placed prior to endovascular treatment, no haemorrhagic complications of neurosurgical intervention were observed. CONCLUSION: The necessity of dual antiplatelet therapy (DAPT) therapy when deploying FDS will rightly continue to limit their use in the acutely ruptured setting to a case-by-case basis whereby other treatment options are deemed unsafe. Methods employed to minimise subsequent haemorrhagic risks from DAPT in these patients may be worthy of further investigation.

Cerebral Nocardiosis: A Rare Cause of Hemiplegia in the Acute Medicine Unit.

Nocardiosis, a rare infection occurring mostly in immunosuppressed patients can present with neurological complications including cerebral abscess formation, and is associated with high morbidity and mortality. We describe the case of a 54-year-old immunocompetent man with cerebral nocardiosis, who presented with sudden onset hemiparesis in an acute medicine unit. He required three craniotomies with excision, following failure to respond to antimicrobial therapy, with subsequent clinical improvement and radiological resolution of multiple cerebral abscesses. Challenges in diagnosis and management of hemiparesis in the acute medical unit are discussed. Successful management of cerebral nocardiosis require early communication with a neurosurgical unit, neuropathology and microbiology services to optimise management with targeted antimicrobial therapy.

Herpes zoster of the trigeminal nerve following microvascular decompression.

A patient developed herpes zoster of the maxillary division of the trigeminal nerve after microvascular decompression. Varicella zoster virus lies dormant in the Gasserian ganglion until reactivation and can cause herpes zoster ophthalmicus. This can result in serious ocular complications including blindness. Antiviral agents are effective if commenced promptly.

Efficacy of botulinum toxin in chronic anal fissure.

BACKGROUND: Chronic anal fissures (CAF) are caused by anal sphincter hypertonia leading to an ischaemic ulcer. By inducing temporary sphincter relaxation, botulinum toxin (Botox) injection has been shown to heal CAF in approximately 73-96% of cases in clinical trials. AIM: This study looks at the efficacy of Botox clinical practice. METHODS: The medical charts were reviewed of all patients with CAF treated with Botox (30iu injected into the sphincter complex in three 10iu aliquots) in the Ulster Hospital, Dundonald, Northern Ireland between March 1999 and November 2001. RESULTS: Fifty-one charts were identified. Four patients failed to attend for review and were excluded from the study. Of the remaining 47 patients, 37 (78.7%) were healed following Botox injection. 10 out of 37 (27.0%) developed a recurrent CAF after a median time of 16.0 months (IQR 3.8-20 months). Eight of these patients opted for repeat Botox injection, which was successful in 7 (87.5%) cases. No adverse effects were reported. CONCLUSION: Botox injection for the treatment of CAF is as effective in clinical practice as reported in clinical trials from specialist centres.