Ranjan Kumar Sahoo

Cerebral venous sinus thrombosis with nontraumatic subdural hematoma

International Journal of Critical Illness and Injury Science | Vol. 5 | Issue 1 | Jan-Mar 2015 Dear Editor, A 60‐year‐old‐patient reported to our hospital with complaints of acute onset of weakness over right side limbs for 2 days and complex partial seizure for 1 day. He was a known diabetic and hypertensive under irregular medication with no history of recent trauma. He had grade‐III power in right side limbs, right side extensor plantar reflex, and bilateral papilledema. Noncontrast computed tomography (NCCT) scan of head shows thin isodense (subacute) subdural hematoma (SDH) over left frontal lobe convexity [Figure 1]. Contrast‐enhanced magnetic resonance imaging (MRI) of brain shows T1W iso to hyperintense, T2W hypointense thin collection over left frontal lobe convexity and occluding thrombus in right transverse, sigmoid sinus and part of superior sagittal sinus. The patient was treated with antidiabetic, antihypertensive drugs and low molecular weight heparin, followed by oral warfarin with maintenance of the prothrombin time, international normalized ratio (prothrombin time INR) at 2:1. The patient recovered well on treatment.

Two concurrent large epidermoid cysts in sublingual and submental region resembling plunging ranula: Report of a rare case

An elderly female patient presented to surgical outpatient clinic with complaint of gradual onset of painless submental and sublingual midline swellings for 6 months of duration. The swellings were noncompressible, nontranslucent, nonpulsatile, and nontender on palpation. Clinical diagnosis was plunging ranula or dermoid cysts. Ultrasound examination of sublingual swelling showed cystic lesion with particulate content. Submental swelling showed cystic swelling with few echogenic floating lobules inside suggesting possibility of epidermoid/dermoid cyst. Magnetic resonance imaging of the face showed homogeneous fluid content within the sublingual cystic lesion and heterogeneous fluid content with few floating nodules within submental swelling. Both cystic lesions were noncommunicative and were showing diffusion restriction and no fat signal. Radiological diagnosis was sublingual and submental epidermoid cysts. She was operated under general anesthesia, and two separate cystic masses were excised with intact capsule. Histopathological diagnosis of masses confirms epidermoid cyst. Several literature have reported isolated sublingual or submandibular epidermoid cyst. However, concurrent sublingual and submental epidermoid cysts with different imaging appearance are rarely reported.

Empty sella syndrome in a male child with failure to thrive.

Empty sella syndrome (ESS) is commonly seen in adult and is considered as an infrequent finding in childhood. It may be diagnosed incidentally on imaging in asymptomatic children. However, most of the children with ESS present with features of hypothalamic-pituitary dysfunction. We report a case of ESS in a child with features of failure to thrive as well as hypopituitarism and review the literature briefly on the subject.

Acute hemorrhage within intradural extramedullary schwannoma in cervical spine presenting with quadriparesis.

Schwannoma with acute hemorrhage is rarely seen. A 44-years-old male patient presented with complaint of neck pain and acute onset of quadriparesis. Magnetic resonance imaging (MRI) of his cervical spine revealed evidence of an intradural extramedullary tumor with intratumoral acute hemorrhage. He was operated in emergency and the mass was found to be schwannoma with acute hemorrhage. Post operatively the patient improved significantly. Though schwannomas show microscopic intratumoral hemorrhage and necrosis at times, schwannoma with acute hemorrhage resulting acute onset of neurological deficit is very uncommon.

Congenital dermal sinus in mid-dorsal spine with large intramedullary dermoid cyst in an 18-months-old child

Intramedullary dermoid cyst is a rare entity. It is usually associated with spinal dysraphism and dermal sinus. Our case is an 18-months-old female child who presented with history of fever and mild difficulty in moving left leg. She had a sinus in mid dorsal spine since birth with history of intermittent discharge from it. On magnetic resonance imaging of spine she was diagnosed to have large intramedullary epidermoid/dermoid cyst in the D2-7 vertebral level with a sinus tract. A dermoid cyst along with the sinus tract was excised. Post-operative follow up period was uneventful with full recovery.

Occipital intradiploic epidermoid presenting as benign intracranial hypertension: A rare manifestation

Presentation of IDEM tuberculoma is usually subacute, but it can be chronic or acute or paradoxical. Contrast MRI is the investigation of choice.[1,2,5,8] Whole craniospinal axis should be scanned with contrast to pick up other asymptomatic lesions in the CNS. Medical treatment alone will not improve the deteriorating neurological status of these patients and surgical resection of the IDEM tuberculoma followed by full course of antitubercular chemotherapy results in good outcome.[4] Despite surgery, full course of ATT is a must for complete cure of the disease, thus avoiding potential neurological morbidity.[9] Also, use of steroids along with ATT is strongly recommended.[8]

Acute spontaneous cervical spinal posterior epidural hematoma in a young adult patient

Cervical laminectomy was done from C4 to C7 level. About 15 g of solid blood clot was evacuated beneath the ligamentum flavum [Figure 2]. No vascular malformation or tumor was seen. Pathological examination of the clot reveals no malignant cells or vascular malformation. The term “spontaneous” has been named here as no precipitating factor or etiology could be identified after investigation and operation. The patient showed gradual improvement of symptoms by 7th post-operative day and was asymptomatic after 3 weeks of follow-up.

A calcified epidermoid cyst within right lateral ventricle: A report of a rare case

A young patient reported to neurosurgery outdoor department with symptoms of increased intracranial pressure. Noncontrast computed tomography examination showed a single calcified mass within right lateral ventricle with mild hydrocephalus. Contrast-enhanced magnetic resonance imaging revealed nonenhancing single mass within right lateral ventricle with mild hydrocephalus. Intraventricular calcified choroid papilloma/calcified epidermoid were radiological differentials. The mass was excised, removed from the lateral ventricles and found to be calcified epidermoid on gross and microscopic examination, which is rare.

Spontaneous puerperal extraperitoneal bladder wall rupture in young woman with diagnostic dilemma

A young female presented with an acute abdominal pain and oliguria for 1 week following normal vaginal delivery. No history of hematuria was present. Patient was having lochia rubra. Sealed uterine rupture was suspected clinically. Initial ultrasound of the patient showed distended urinary bladder containing Foley catheter ballon with clamping of Foley catheter and particulate ascites. Abdominal paracentesis revealed hemorrhagic fluid. Contrast-enhanced computed tomography of abdomen revealed ascites, distended urinary bladder and no extraluminal contrast extravasation in delayed scan. As patient condition deteriorated, repeat ultrasound guided abdominal paracentesis was done which revealed transudative peritoneal collection with distended bladder. Cystoscopy revealed urinary bladder ruptures with exudate sealing the rupture site. Exploratory laparotomy was done and a diagnosis of extraperitoneal bladder rupture was confirmed. The rent was repaired in layers. She was put on continuous bladder drainage for 3 weeks followed by bladder training. It presented in a unique way as there was hemorrhagic peritoneal tap, no macroscopic hematuria and urinary bladder was distended in spite of urinary bladder wall rupture which delayed the diagnosis and treatment. Complete emptying of urinary bladder before second stage of labor and during postpartum period with perineal repair is mandatory to prevent urinary bladder rupture.

Tuberculosis verrucosa cutis complicated with Pott's spine and a large iliopsoas abscess in a young pregnant woman: A case report and review of the literature

A young female patient reported to the dermatologist with a skin lesion that was diagnosed as tuberculosis verrucosa cutis (TVC) after skin biopsy. She did not continue antitubercular drugs as she was having vomiting due to pregnancy. She reported to our hospital with swelling and pain in the abdomen with 18 weeks of pregnancy. On imaging, she was diagnosed to have large iliopsoas abscess with tubercular spondylitis. She took antitubercular drugs after surgical drainage of the iliopsoas abscess. She delivered a healthy male baby. Follow-up imaging revealed resolution of the skin lesion, iliopsoas abscess, and tubercular spondylitis.