A Case Report on May-Thurner Syndrome: Beyond the Usual Suspects.

May-Thurner syndrome (MTS), also known as iliocaval venous compression syndrome, is a vascular condition characterized by extrinsic venous compression within the iliocaval territory. While traditionally considered a condition predominantly affecting women, this case report presents an atypical presentation in a middle-aged male patient. The patient initially presented with left lower extremity pain and swelling, which was attributed to deep venous thrombosis (DVT) in the left calf and femoral vein. Despite anticoagulation therapy, his symptoms persisted, leading to further diagnostic evaluation and the identification of MTS. This report highlights the clinical presentation, diagnostic challenges, and successful management of MTS in a male patient. Endovascular interventions, including balloon dilation and stent placement, were employed to address refractory stenosis and thrombus burden. The case emphasizes the importance of considering MTS as a potential diagnosis in patients with unexplained lower limb symptoms, irrespective of traditional risk factors or gender. Early identification and appropriate interventions can lead to symptom relief, obstruction resolution, and improved long-term outcomes for patients with MTS. This case underscores the need for heightened clinician awareness regarding MTS and its potential impact on patient care.

A Case Report of Candida-Induced Emphysematous Gastritis.

Emphysematous gastritis is a rare entity that has not much literature available. It is known to manifest as a diffused wall inflammation and air within the wall of the stomach and has been associated with gas-forming organisms. We present a complex case of a middle-aged woman with a previous history of fulminant Clostridium difficile complicated with colectomy and diverting colostomy. She was admitted due to diabetic ketoacidosis, later complicated with worsening abdominal pain, and a CT scan of the abdomen and pelvis without contrast revealed findings consistent with ischemic bowel, severe pneumatosis intestinalis, and extensive portal venous gas. A stomach biopsy revealed hemorrhagic necrosis; a Gomori methenamine silver stain was compatible with fungal organisms, Candida species, correlating with Candida emphysematous gastritis. This case highlights the importance of early diagnosis of this syndrome in order to provide appropriate management, and early identification, to improve survival.

A Case Report of Subacute Combined Degeneration Due to Nitrous Oxide-Induced Vitamin B12 Deficiency.

Nitrous oxide, also known as "laughing gas," is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, its recreational use is on the rise. We present a case of subacute combined degeneration (SCD) due to nitrous oxide-induced vitamin B12 deficiency. The patient presented with bilateral lower extremity paresthesia, weakness, and ataxic gait. The patient was found to have vitamin B12 deficiency. An MRI of the cervical spine revealed an abnormal T2 signal within the cervical spinal cord extending from the level of C2-C6 affecting only the posterior column. On the fifth day of hospitalization, the patient reported that he had been inhaling nitric oxide from whipped cream cans for recreational use. According to his clinical presentation and laboratory and imaging findings, we concluded that the patient had SCD. The patient slowly improved after receiving vitamin B12 supplementation therapy. Patients presenting with paresthesia, weakness, and laboratory studies indicating vitamin B12 deficiency should be questioned about nitrous oxide recreational use since the incidence is increasing.

When Two Worlds Collide: A Rare Case of Multiple Myeloma With Extramedullary Plasmacytoma.

In this case report, we discuss the presentation, diagnosis, and management of a 67-year-old gentleman with stage II multiple myeloma with concurrent biopsy-proven bone plasmacytoma and why it is important to understand the molecular intricacies of these disorders. We emphasize the critical role of radiology in identifying, characterizing, and managing these lesions. Furthermore, we shed light on the critical differentiation between solitary extramedullary plasmacytoma and multiple myeloma and discuss treatment modalities for both conditions.

When Sight and Cancer Collide: A Rare Case of Paraneoplastic Bilateral Optic Neuritis.

Bilateral acute optic neuritis is a rare and challenging clinical presentation, often associated with conditions like multiple sclerosis or neuromyelitis optica spectrum disorder. We present the case of a 40-year-old woman with a complex medical history, including poorly differentiated squamous cell carcinoma of the cervix (stage IIIC), who presented with a swift and profound bilateral vision loss. Despite initial treatment with high-dose methylprednisolone and therapeutic plasma exchange, her optic nerve enhancement on MRI and negative autoantibody results raised suspicion of paraneoplastic optic neuritis. This prompted consultation with oncology, and the patient initiated chemotherapy. The rapid onset and progression of bilateral optic neuritis in the context of cervical carcinoma emphasize the importance of considering paraneoplastic syndromes in such cases. A multidisciplinary approach involving neurology, ophthalmology, and oncology specialists is vital for the diagnosis and management of these complex presentations. This case underscores the need for heightened awareness of paraneoplastic etiologies in patients with malignancies and unexplained neurological symptoms.

The Importance of Radiologic Imaging Modalities in Autosomal Dominant Polycystic Kidney Disease.

Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder that occurs in approximately one in 1000 live births. Patients may be asymptomatic or present with symptoms such as hypertension, hematuria, proteinuria, or renal function impairment. It can present with extra renal complications like cerebral aneurysms, hepatic and pancreatic cysts, infected cysts, cardiac valve disease, colonic diverticula, abdominal wall and inguinal hernia, and seminal vesicle cyst. Imaging studies such as ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) provide vital information regarding the diagnosis of the disease, monitoring of the progression of the disease, and detection of complications from the disease. We present the case of a 40-year-old male who developed extra-renal complications, and how different imaging modalities facilitated and enabled us to optimize the care of this patient in a timely manner.

Neurofeedback in healthy elderly human subjects with electroencephalographic risk for cognitive disorder.

In normal elderly subjects, the best electroencephalogram (EEG)-based predictor of cognitive impairment is theta EEG activity abnormally high for their age. The goal of this work was to explore the effectiveness of a neurofeedback (NFB) protocol in reducing theta EEG activity in normal elderly subjects who present abnormally high theta absolute power (AP). Fourteen subjects were randomly assigned to either the experimental group or the control group; the experimental group received a reward (tone of 1000 Hz) when the theta AP was reduced, and the control group received a placebo treatment, a random administration of the same tone. The results show that the experimental group exhibits greater improvement in EEG and behavioral measures. However, subjects of the control group also show improved EEG values and in memory, which may be attributed to a placebo effect. However, the effect of the NFB treatment was clear in the EG, although a placebo effect may also have been present.

A neurofunctional evaluation strategy for presurgical selection of temporal lobe epilepsy patients.

Introduction Temporal lobe epilepsy (TLE) is the prototype of a surgically correctable syndrome. Successful surgical outcomes depend on a thorough presurgical evaluation aimed primarily at identifying the epileptogenic zone. Objective Describe the noninvasive presurgical selection and evaluation strategy for TLE patients introduced at the International Neurological Restoration Center (CIREN) in Havana, Cuba, and evaluated between 2001 and 2006 for its accuracy in identifying candidates for non-lesional resection surgery. Methods Ictal onset electrographic patterns of 1,679 seizures in 72 patients with drug-resistant partial epilepsy, obtained through longterm scalp Video EEG (V-EEG) monitoring, were evaluated. The correlation between the V-EEG-defined epileptogenic zone and the dysfunction shown by single photon emission computed tomography (ictal and interictal brain SPECT) and nuclear magnetic resonance spectroscopy (MRS) was established. Results V-EEG monitoring determined that 44.4% of evaluated patients had complex partial temporal lobe seizures. Identification of patients with medial temporal epilepsy (MTE) increased as a result of lateralization and localization of the dominant mean ictal pattern frequency (5.56 ± 1.31 Hz) during the period of maximum spectral power VARETA localization of an ictal epileptiform activity source coincided with the epileptogenic zone in all TLE patients who subsequently underwent a successful temporal lobectomy. Semiquantitative analysis of ictal and interictal brain SPECT images, as well as metabolic ratios measured by MRS, combined with V-EEG findings, enabled localization/lateralization of the epileptogenic zone in TLE patients whose MRIs were normal or showed bilateral structural abnormalities. Conclusions Confirmation of correct localization/lateralization of the epileptogenic zone following successful surgical outcomes in selected TLE patients led CIREN to develop a surgical treatment strategy for patients in Cuba with drug-resistant temporal lobe epilepsy. This strategy offers an appropriate, cost-effective treatment alternative for developing countries like Cuba, with the benefit of significantly improving TLE patients' quality of life.

Endoscopic balloon dilation of anastomotic strictures occurring after laparoscopic gastric bypass for morbid obesity.

BACKGROUND: Gastrojejunal anastomotic stenosis of laparoscopic Roux-en-Y gastric bypass (LRYGB) for morbid obesity occurs in 3-25% of cases. The aim of this report was to evaluate the utility of endoscopic balloon dilation for the therapy of anastomotic strictures after LRYGB. PATIENTS AND METHODS: 111 consecutive patients were treated with endoscopic dilation under sedation with propofol. Dilations were performed with through-the-scope over-the-wire balloons, with sizes ranging from 6 to 18 mm. The outcomes of the procedure were analyzed. RESULTS: 200 endoscopic balloon dilations were performed in 111 patients. Repeated dilations were necessary in patients with complex stenosis. In 75% of the patients it was possible to dilate to 12 mm during the first session. Only in 2% of the cases was it impossible to introduce the endoscope through the stenosed anastomosis after dilation. On follow-up a repeat dilation was necessary in 26% of the cases. Minor complications occurred in 2.7% of patients (2 concealed perforations and 1 hematoma of the esophagus). These were treated conservatively. None of the patients required operation. CONCLUSIONS: Endoscopic balloon dilation is a safe and effective therapy for anastomotic strictures occurring after LRYGB.

Changes in EEG current sources induced by neurofeedback in learning disabled children. An exploratory study.

The objective of this work was to explore Neurofeedback (NFB) effects on EEG current sources in Learning Disabled (LD) children, and to corroborate its beneficial consequences on behavioral and cognitive performance. NFB was given in twenty 30-min sessions to 11 LD children to reduce their abnormally high theta/alpha ratios (Experimental Group). Another five LD children with the same characteristics received a placebo treatment (Control Group). In the Control Group no changes in behavior or EEG current source were observed. In the Experimental Group, immediately after treatment children showed behavioral and cognitive improvements, but current source analysis showed few modifications; however, 2 months after treatment many changes occurred: a decrease in current of frequencies within the theta band, mainly in left frontal and cingulate regions, and enhancement in current of frequencies within the alpha band, principally in the right temporal lobe and right frontal regions, and of frequencies within the beta band, mainly in left temporal, right frontal and cingulate cortex regions. In conclusion, NFB is a possibly efficacious treatment for LD children with an abnormally high theta/alpha ratio in any lead. The changes observed in EEG current sources may reflect the neurophysiological bases of the improvement that children experienced in their behavioral and cognitive activities.

Assessing acute middle cerebral artery ischemic stroke by quantitative electric tomography.

This paper focuses on the application of quantitative electric tomography (qEEGT) to map changes in EEG generators for detection of early signs of ischemia in patients with acute middle cerebral artery stroke. Thirty-two patients were studied with the diagnosis of acute ischemic stroke of the left middle cerebral artery territory, within the first 24 hours of their clinical evolution. Variable Resolution Electrical Tomography was used for estimating EEG source generators. High resolution source Z-spectra and 3- dimensional images of Z values for all the sources at each frequency were obtained for all cases. To estimate statistically significant increments and decrements of brain electric activity within the frequency spectra, the t-Student vs. Zero test was performed. A significant increment of delta activity was observed on the affected vascular territory, and a more extensive increment of theta activity was detected. A significant alpha decrement was found in the parieto-occipital region of the affected cerebral hemisphere (left), and in the medial and posterior region of the right hemisphere. These findings suggest that qEEGT Z delta images are probably related to the main ischemic core within the affected arterial territory; penumbra, diaschisis, edema, might explain those observed theta and alpha abnormalities. It was concluded that qEEGT is useful for the detection of early signs of ischemia in acute ischemic stroke.

N400 during lexical decision tasks: a current source localization study.

OBJECTIVE: Our primary aim in the present study was to establish the anatomic and psychophysiological correlates of automatic and controlled semantic priming. METHODS: Current sources were calculated on N400 component data from a previous study on lexical decision tasks [Clin Neurophysiol 1999;110:813] using the variable resolution electromagnetic tomography method (VARETA). In this study, two experiments were carried out, one using directly related pairs and the other one using mediated related pairs. Each experiment consisted of 3 tasks that required different levels of contribution from controlled processes. RESULTS: Average source localization images showed the brain structures involved in lexical decision tasks. The automatic component of the N400 effect was related to activation of occipitotemporal and parahippocampal gyri and anterior temporal lobes bilaterally. The expectancy strategy was related to activation of the right posterior temporal and right frontal areas. The postlexical strategy was associated with activation of right frontal, anterior cingulate and bilateral superior parietal areas. CONCLUSIONS: The findings indicated that the current sources of the N400 varied according to the relative contributions of automatic and controlled mechanisms. Moreover, the sources of the N400 effect depended on the type of strategy used.

Sources of abnormal EEG activity in spontaneous intracerebral hemorrhage.

UNLABELLED: This report describes the results obtained with EEG source analysis in the frequency domain (FD-VARETA), in 14 patients with brain hemorrhages; 6 hemorrhages were located in the putaminal region, 1 was mesencephalic and 7 were lobar cerebral hemorrhages. Our goal was to evaluate FD-VARETA accuracy for the localization of fast growth expansive brain lesions. FD-VARETA produces brain electromagnetic tomography images of EEG sources in every frequency. The location of the most abnormal or the maximum Z value across all frequencies was compared with the location of spontaneous hemorrhages in computed tomographies (CT). In all patients the main source was within delta or theta bands. The spatial extent of the sources, in the brain atlas, at these frequency values was almost the same as the volume of hematoma in CT. Putaminal lesions produced larger regions of cortical deafferentation than lobar hematomas, with higher abnormal Z values. FD-VARETA was more accurate in locating the lesions than traditional maps of absolute and relative power in delta, theta, alpha and beta bands. CONCLUSION: FD-VARETA is a valuable procedure for the functional evaluation of brain hemorrhages.