A rare case of intralesional haemorrhage of a benign aqueductal cyst after CSF diversion treatment. A case report and review of literature.

Benign cysts within the pure aqueductal region are a rare entity. Their critical location within the ventricular system presents a risk of potentially catastrophic outcomes. We present a case of a 68-year-old female who was transferred to our unit with an acute obstructive triventricular hydrocephalus caused by a benign cyst within the cerebral aqueduct. She became unconscious and had an urgent endoscopic third ventriculostomy (ETV). Post-operatively, the patient was recovering well but then developed a sudden onset severe headache accompanied by vomiting. Imaging revealed intracystic haemorrhage with expansion of lesion but there was no obstructive hydrocephalus due to CSF diversion performed 9 d prior. She was treated conservatively and continued to improve.

Validation and improvement of a proposed scoring system to detect retained common bile duct stones in gallstone pancreatitis.

BACKGROUND: In 2009, a study from our institution used retrospective data and multivariate analysis to identify 5 quantitative variables and their cutoffs that have a positive predictive value (PPV) for common bile duct (CBD) stones in gallstone pancreatitis. They also proposed a management protocol based on the scoring system. This prospective study sought to validate that scoring system. METHODS: From October 2009 to August 2013, patients with gallstone pancreatitis were enrolled in the study. Scores of 0-5 were determined at admission, with 1 point for each criterion met: CBD ≥ 9 mm, gamma glutamyltransferase ≥ 350 U/L, alkaline phosphatase ≥ 250 U/L, total bilirubin ≥ 3 mg/dL, and direct bilirubin ≥ 2 mg/dL. All CBDs were assessed using intraoperative cholangiogram, MR cholangiopancreatography (MRCP), or endoscopic retrograde cholangiopancreatography (ERCP). RESULTS: Of 84 patients, 16 had CBD stones. A score of 0 had negative predictive value (NPV) of 100% for CBD stones (P < .001). Scores of 1 and 2 had NPV of 81% and 83%, respectively. A score of 3 had NPV of 60%. A score of 4 had PPV of 67% (P = .002). A score of 5 had PPV of 100% (P < .001). The overall accuracy of the scoring system was 88%. CONCLUSION: The scoring system is accurate in prediction of CBD stones in patients with gallstone pancreatitis. We propose that patients with 0 points undergo laparoscopic cholecystectomy, 1 and 2 points undergo laparoscopic cholecystectomy with intraoperative cholangiogram, 3 and 4 points undergo MRCP, and 5 points undergo ERCP as the first step in management for gallstone pancreatitis. The proposed protocol eliminated negative ERCPs.

Cervical intramedullary melanocytoma: a case report and review of literature.

Meningeal melanocytomas are rare tumours of the central nervous system, most commonly found in the intracranial compartment (posterior cranial fossa). Spinal lesions are uncommon, with the majority being intradural, extramedullary lesions. Intramedullary melanocytomas are extremely rare and are most commonly found in the thoracic region. We report a patient with cervical intramedullary melanocytoma and review the available literature regarding this rare pathology.

Progressive ulnar neuropathy caused by delayed migration of a foreign body.

Foreign bodies in the hand can cause a variable degree of acute or delayed injuries to the important structures. We report a rare case of a progressive ulnar neuropathy caused by delayed migration of a foreign body in the forearm. Ultrasonographic localisation and surgical removal of the foreign body resulted in gradual recovery of neurological function.