Rare case of bilateral petrous apex cephalocele.

The petrous apex is a pyramidal-shaped structure which is difficult to examine due to difficult anatomical location. Lesions in the petrous apex can be managed surgically or they can be incidental lesions, which are managed conservatively. Petrous apex cephaloceles (PAC) are the cystic lesion due to herniation in the Meckel's cave of temporal bone. Bilateral PAC is a very rare phenomenon with only 21 cases reported in the literature so far. We present here a case of bilateral PAC, who presented with headache and was managed conservatively.

Evaluation of CT and MRI Findings among Patients Presented with Chief Complaint of Headache in Central India.

INTRODUCTION: Headache is one of the most common presenting complaints in day to day medical practice however the secondary causes of headache are uncommon. Thus, appropriate selection of headache patient (Pt) is important to determine those that require neuroimaging due to likely secondary cause. Red flags and Clinical warning criterion (CWC) act as a screening tool to help in identifying those who may get benefit from neuroimaging. AIM: To evaluate the findings of computed tomography (CT) and Magnetic Resonance Imaging (MRI) among patients presented with the chief complaint of headache and to compare the findings between two groups of patients. MATERIALS AND METHODS: This retrospective observational study was carried out in 500 selected patients, who underwent CT or MRI scan of head in Peoples College of Medical Sciences and Research centre, Bhopal, MP during the period of 2 year in between Jan 2013 to Dec 2014. Siemens Somatom sensation 40 slice MDCT and Siemens magnetom 1.5T MRI scanner were used for imaging. Five hundred patients of 10 to 70 year age were selected for the study based on our criterions of selection. RESULTS: All 500 patients were divided in to two groups A and B based on presence or absence of red flag signs and CWC signs. Group A consists of 48 patients having one or more red flag or CWC signs and group B consists of 452 patients those don't have any above signs. 29 cases (60.4%) out of total 48 cases of group A is suffering from chronic headache as compared to 97 cases (21.5%) out of total 452 patients of group B is having positive findings (p-value<0.05). Out of 500 patients, only 29 cases (5.8%) revealed some form of brain parenchymal pathology whereas other associated findings were seen in 97 cases e.g. sinusitis in 58 (11.6%), bone related pathology in 26 (5.2%) and chronic suppurative otitis media (CSOM) in 13 (2.6%) patients. CONCLUSION: CT/MRI in patients without red flag or CWC sign yields very low percentage of clinically significant positive findings in neuroimaging. In the absence of these, the only reason for CT or MRI scan seems to reassure the patients and their loved ones. CT or MRI as a screening tool in these patients has limited value in term of cost effectiveness.

An infant with nasal regurgitation since birth and failure to thrive.

The condition achalasia cardia is rare in paediatric age group, especially in infants. An 11-month-old female infant presented with complaints of oronasal regurgitation since birth and failure to thrive. Upper GI contrast study was conducted which demonstrated massive dilatation of lower 2/3(rd) of oesophagus with abrupt narrowing at lower oesophageal sphincter and positive 'bird beak sign'. On the basis of radiological findings infantile achalasia cardia was diagnosed and patient underwent modified Heller's Oesophagocardiomyotomy with anti reflux procedure. Post operatively the symptoms subsided and weight gain was noted after six month follow up. Although functional infant regurgitation and Gastro-oesophageal reflux (GER) is common in infancy, uncommon causes like achalasia cardia should also be considered as a differential when symptoms are persisting.

Acute pelvic pain: a ball pen may be a cause?

Chronic Urinary tract infection (UTI) is a common problem in women and can be seen without any significant anatomical and functional pathology. Foreign bodies within the urinary bladder are not rare and should be considered as a cause of chronic and recurrent UTI. Intravesical foreign bodies can be self inflicted, iatrogenic or migration from adjacent organs. History in these cases is often misleading and presentation of foreign body mostly becomes apparent as suprapubic pain, dysuria with or without hematuria. We present a case of self-inflicted foreign body within the bladder of a young female who presented with recurrent urinary tract infections for six months that did not respond to medical treatment.