Favourable Outcome in a 33-Year-Old Female with Acute Haemorrhagic Leukoencephalitis.

BACKGROUND: Acute haemorrhagic leukoencephalitis (AHLE) is a rare and rapidly fatal disease of unknown aetiology. There is a paucity of literature on the presentation and management of this rare disease. CASE DESCRIPTION: We report the case of a 33-year-old female presenting with headache and left-sided apraxia. Imaging revealed a right-sided white matter lesion with extensive cytotoxic oedema. Pathology was suggestive of AHLE. She underwent an open excisional biopsy and was treated with high-dose corticosteroids. Three months since symptom onset she remains clinically well with resolving apraxia and radiological appearance. CONCLUSION: This case may represent a milder spectrum of AHLE, which responded favourably to corticosteroids.

Pathogenesis of diverticulosis and diverticular disease.

Diverticulosis is defined by the presence of diverticula due to herniation of mucosa and muscularis mucosa through the muscularis propria at sites of vascular penetration in the colon and is asymptomatic in the vast majority affected. There are global differences of distribution, in Western industrialized societies, the most common site is in the left colon, but in Asia right sided diverticulosis predominates. Whilst present in 17.5% of a general population and 42% of all comers at endoscopy it is seen in 71% of those aged ≥80 years. Diverticular disease is defined as clinically significant and symptomatic diverticulosis, which may have an absence of macroscopically overt colitis and in true diverticulitis there is macroscopic inflammation of diverticula with related acute or chronic complications. Whilst overall, diverticulitis affects only 4% of those with diverticulosis, in younger patients (aged 40-49 years) this peaks at 11%. Diverticulosis is one of the most common chronic diseases, yet research in this field on pathogenesis has lagged behind other common conditions such as diabetes mellitus. However, in the last decade there have been major advances in taxonomy that can be used to relate to patients' outcome and treatment in both medicine and surgery. It has been shown there is an association with age, diet, drugs and smoking. Genetic studies have shown a familial association and a specific gene, TNFSF 15 may predict severity of disease. The role of the microbiome has been explored and microbial and metabolomic signatures are also important in predicting disease severity. That diverticulosis is a chronic disease is shown by mucosal pathology with subtle chronic inflammation present in those with asymptomatic diverticulosis and inflammation may lead to muscular hypertrophy, enteric nerve remodeling with disordered motility. The diverticulitis quality of life instrument shows that this condition impacts markedly on patients' well-being and prevention and amelioration of complications should be the aim of treatment and further research to attain this goal is needed.

A GP primer to understanding biopsy reports of the lower gastrointestinal tract.

BACKGROUND: Colonoscopic biopsies are taken to make a diagnosis of inflammation, dysplasia or malignancy, to assess treatment success and to monitor patients' progression. OBJECTIVE: This aim of this article is to provide a guide to understanding histology reports sent to the general practitioner (GP) from the colonoscopy and anatomical pathology departments for the diagnosis of increasingly prevalent gastrointestinal (GI) diseases. DISCUSSION: Many diseases in the lower GI tract are increasing in prevalence and new diseases are emerging that require biopsy for diagnosis. Cancer surveillance programs require colonoscopy for polyp detection, and histology to evaluate polyps and subsequent cancer risk in the large bowel. Inflammatory bowel disease is also increasing in incidence, and patients are diagnosed and monitored with endoscopy and biopsy. Drugs can also affect the GI tract and endoscopy can detect damage with confirmation by biopsy.

A GP primer for understanding upper gastrointestinal tract biopsy reports.

BACKGROUND: Endoscopic biopsies of the upper gastrointestinal (GI) tract are taken to make a diagnosis of inflammation, dysplasia or malignancy, to assess treatment success and monitor patients' progress. OBJECTIVE: This article provides a guide to understanding histology reports sent to general practitioners (GPs) from endoscopy and anatomical pathology providers for the diagnosis of increasingly prevalent upper GI diseases. DISCUSSION: Many upper GI diseases are increasing in prevalence and new diseases are emerging that require biopsy for diagnosis. Oesophageal disease (particularly gastro-oesophageal reflux disease and eosinophilic oesophagitis) and coeliac disease (real and perceived wheat sensitivity) are common. However, infection with Helicobacter pylori is declining. Drugs can also affect the GI tract, and endoscopy can detect damage with biopsy confirmation.