Endovascular embolization for the treatment of epistaxis: Systematic review and meta-analysis.

BACKGROUND: Endovascular embolization (EE) is a treatment option for epistaxis refractory to first-line interventions. Data regarding embolization is limited to small case series and a meta-analysis has not been performed. METHODS: PubMed, Scopus, and EMBASE were used to identify studies that reported outcomes for at least 10 patients undergoing EE for epistaxis. Outcomes included procedural success, rebleeding, and complications. Pooled rates for each outcome were obtained with random effects models. RESULTS: A total of 44 studies comprising 1664 patients met the inclusion criteria. The mean age ranged from 28.1 to 67 years and there were 28.4% females. The pooled procedural success rate was 87% (95% CI 83.9-89.6, I2 = 53%). Age (OR 0.95, 95% CI 0.91-1) and hereditary hemorrhagic telangiectasia ([HHT], OR 0.97, 95% CI 0.96-0.99) were associated with decreased odds of success. The pooled rebleeding rate was 16.4% (95% CI 13.6-19.6, I2 = 48%), and HHT was associated with greater odds of rebleeding (OR 1.02, 95% CI 1-1.03). The pooled overall complication rate was 14.4% (95% CI 9.8-20.6, I2 = 85.8%). The pooled rates of stroke and vision loss were 2.1% (95% CI 1.5-3.1, I2 = 1.5%) and 1.8% (95% CI 1.2-2.6, I2 = 0%), respectively. CONCLUSION: EE for epistaxis has a high rate of procedural success. Interventionalists should be aware of the risk for rebleeding, especially among patients with HHT.

Striatal dominant lupus encephalitis-Is it vasculitis or an autoimmune process? Literature review & new case report with vessel wall imaging.

Neurological and psychiatric symptoms are highly prevalent in the initial manifestation of systemic lupus erythematosus (SLE) and is classified as neuropsychiatric systemic lupus erythematosus (NPSLE). Despite the high prevalence rate of this condition, it is still very poorly understood and often delayed in its diagnosis due to its variety in clinical manifestations. For our case, an eighteen-year-old male who was recently diagnosed with SLE presented with progressive confusion, visual and auditory hallucinations, in addition to high fevers, diarrhea, abdominal and flank pain. Upon initial presentation, he was treated for sepsis while trying to identify a source of infection. However, with the help of laboratory tests like CSF analysis and autoantibody serum studies as well as neuroradiologic imaging, we were able to rule out infectious causes and diagnose our patient with lupus induced striatal encephalitis. We present the first case of striatal encephalitis with vessel wall imaging to ultimately rule out lupus associated vasculitis. The importance of MRI imaging and identification of specific patterns associated with autoimmune encephalitis allowed rapid diagnosis and initiated immediate treatment in the hopes of reducing long term affects from neuroinflammation in our young patient.

Pediatric fibrocartilaginous spine embolism induced by trauma.

Fibrocartilaginous embolic infarction of the spinal cord is a rare cause of acute back pain and motor weakness. Most symptoms start after minor trauma that is often considered harmless and forgotten, however these minor injuries can result in lethal consequences. It is quite rare to diagnose fibrocartilaginous embolism in a timely manner and start treatment to prevent poor outcomes. We present the case of a previously healthy eight-year-old female with sudden onset neck pain and progressive bilateral upper extremity weakness following an injury while playing with her younger sister. Magnetic resonance imaging of the cervical spinal cord without contrast revealed a posterior disc protrusion suggestive of post-traumatic spinal cord infarction due to fibrocartilaginous embolism. In young, otherwise healthy, patients with acute motor deficits, radiographic imaging can help identify rare presentations like fibrocartilaginous embolism in order to rapidly diagnose and efficiently treat such patients.