Retroperitoneal Migration And Transgluteal Extrusion of a Distal Lumboperitoneal Shunt Catheter: An Unusual Complication of Cerebrospinal Fluid Shunt.

Cerebrospinal fluid shunts provide many and different complications. Only 1-3% of them are rare, related to migration, and perforation of hollow organs. Even more unusual are the complications associated with the distal catheter leaving the peritoneal cavity and the tip migrating through some of the anatomical foramens to the muscle layers on the back. We present a rare complication, migration of the distal lumboperitoneal shunt catheter through the retroperitoneum and the gluteal muscles to the hypoderma. The peritoneal catheter entered the retroperitoneal area, passed through the greater sciatic foramen below the piriformis, and through the gluteal muscles, before it reached the hypodermal area. Despite the continuous improvement of the material of flexible silicone catheters, injuries of hollow organs with subsequent migration to unusual areas still occur. Our case is the only one that has been reported, in which the catheter made its way through the retroperitoneum and the gluteal muscles.

Social Cognition Impairments in Patients with Multiple Sclerosis: Comparison with Grade of Disability.

OBJECTIVES: Social cognitive impairments are an essential aspect of general disability in patients with multiple sclerosis (MS). They can manifest independently or in addition to physical deficits. AIM: To examine the impairment of social cognition and its potential relationship with the grade of disability in MS patients. SETTINGS AND DESIGN: Our study included 17 healthy controls and 36 patients with clinically definite MS (relapsing-remittent form) according to the McDonald Criteria (2010). The patients were divided into two groups - patients with Expanded Disability Status Scale (EDSS) <3.5 (N = 18) and those with EDSS ≥3.5 (N = 18). The neuropsychological battery included empathy assessment (Self-Compassion, "Reading the Mind") and theory of mind tests - ToM (Faux pas, cartoons). RESULTS: We did not register a change in self-assessment empathy in MS. Reading the Mind in Eye test showed a clear tendency for deterioration with increasing physical disability. The statistically significant difference (P < 0.05) between the results of controls and patients with EDSS ≥3.5 was registered. The tests for interpreting stories perceived in an auditory manner ("faux pas") showed a clear trend toward "failure" among patients (P < 0.05). The results of patients with high disability in ToM cartoons task were statistically worse (P < 0.01) both in comparison to those of controls and patients with EDSS <3.5. CONCLUSION: Our study found that, during the course of MS, deterioration of both social cognitive skills and basic cognitive abilities occurs, which is parallel to physical disability.