An Acute Cervical Subdural Hematoma as the Complication of Acupuncture: Case Report and Literature Review

Therapeutic Options for Migraines in the Microsurgical Patient: A Scoping Review

BACKGROUND

There exists an increasing array of treatments proposed to prevent, alleviate, and abort symptoms of a migraine; however, for patients who undergo reconstructive microsurgery, caution must be taken to preserve vascular integrity. This study is the first-to-date scoping review of vascular and bleeding risk of current migraine therapies, with the purpose of identifying potential therapeutic agents for postoperative migraine management appropriate for microsurgical patients.

METHODS

Currently available migraine therapeutics were compiled from the UpToDate software system and the American Academy of Family Physicians. A PubMed literature review was performed for each therapeutic's effect on bleeding or vascular involvement. Data were compiled into tables of abortive, symptom-controlling and prophylactic, and nonpharmacologic treatments. Expert microsurgeons reviewed the data to provide recommendations for optimized patient care.

RESULTS

Triptans and other ergot derivatives demonstrated strong evidence of vasoconstriction and were greatly advised against for immediate postmicrosurgical use. Novel pharmaceutical therapies such as lasmiditan and calcitonin gene-related peptide antagonists have no literature indicating potential for vasoconstriction or hematoma and remain an investigational option for abortive medical treatment. For symptom control, acetaminophen appears the safest option, with clinical judgment and further research needed for use of nonsteroidal antiinflammatory drugs. Alternative treatment techniques may include migraine prophylaxis with botulinum toxin injection or nutraceutical treatment by means of magnesium supplementation or coenzyme Q10 administration, minimizing the need for additional medication in the postoperative setting.

CONCLUSIONS

Patients undergoing reconstructive microsurgery have a unique medical profile limiting the therapeutic options available to treat migraines. This review provides preliminary evidence to be considered as a guide for prescribing therapeutics for migraine in the postoperative setting.

Acute supratentorial subdural hematoma after craniocervical junction arachnolysis in a patient with posttraumatic syringomyelia; case report and literature review

In patients with SAA rapid CSF drainage while performing durotomy must be avoided by utilizing cotton pads and lowering the head level to avoid catastrophic complications.

Endoscopic Removal Through a Gastrostomy of Swallowed Acupuncture Needles

Acupuncture is a representative treatment field in oriental medicine that is used widely in various medical conditions. Although acupuncture is considered a safe procedure, it can cause complications. This paper reports the case of a 44-year-old quadriplegic woman who received a percutaneous gastrostomy (PEG) tube and was referred for the endoscopic removal of swallowed acupuncture needles. The needles were removed successfully by endoscopy through the PEG tube using the rendezvous technique without significant complications.

Not Everything Requires a Psychiatry Consult: Subdural Hematoma as a Cause of Transient Acute Quadriplegia

While subdural hematoma (SDH) is a commonly encountered emergent pathology that is often in the setting of trauma, its ability to present with a wide variety of symptoms, or no symptoms at all, may delay diagnosis. SDH symptoms progress in a stepwise manner, potentially resulting in rapid neurological degeneration and can result in irreversible damage. Here we describe a case of an elderly woman with bilateral chronic SDH with mass effect who initially presented with severe headaches and a mild altered mental status, notably without a history of head trauma. Diagnosis was achieved through radiographic imaging. Within 24 hours, the patient suddenly became quadriplegic. Emergent bilateral evacuation of SDH was performed. Full neurological recovery of both arms and legs was achieved without delay, demonstrating the ability of this approach to reverse the development of acute quadriplegia attributed to SDH in such patients. Comprehensive and timely medical screening on initial presentation accompanied by radiographic studies, especially of patients presenting with altered mental status is crucial for identifying any underlying pathology, such as SDH. Altered mental status without head trauma is not always psychologic in nature and a psychiatric consult is insufficient in identifying lesions of the central nervous system (CNS). Altered mental status encompasses a broad differential diagnosis that seeks to find organic causes of altered state. While mortality from symptomatic chronic SDH is high, especially in the geriatric patient population, our findings support the position that rapid diagnosis and intervention to reverse neurological deterioration is an essential component of improving patient outcomes.

Underestimated Cervical Extradural Hematoma Secondary to the Small Needle-Scalpel for the Treatment of Cervical Spondylosis: A Rare but Avoidable Complication

Objective: To present a case report highlighting a severe, yet avoidable, complication following small needle-scalpel treatment for cervical spondylosis.

Introduction: The small needle-scalpel is a miniature surgical instrument used to create intense and invasive punctures at certain acupoints with a small latch needle. It has been increasingly gaining popularity among clinicians and patients all over the world during the past years. However, severe complications after small needle-scalpel treatment have not previously been reported.

Methods: Here we report a 54-year-old man who recently suffered from cervical spondylosis and underwent small needle-scalpel treatment, which was performed by a rural doctor. While there were no new neurologic deficits, the patient experienced delayed functional deterioration until the onset of quadriplegia within 1 month of treatment. Magnetic resonance imaging demonstrated a C2–C7 dorsally placed extradural hematoma with severe cord compression and subcutaneous soft tissue hemorrhage.

Results: The patient refused urgent corrective surgery and later died due to respiratory failure.

Conclusions: Although small needle-scalpel therapy has many benefits, such as reducing pain, shorter expenditure, shorter period of therapy and better recovery of function, there are also many potentially severe risks, such as cervical extradural bleeding, which requires clinicians to pay more attention to avoid the complications.

Idiopathic cervical spinal subdural haematoma: a case report and literature review

This report describes a case of idiopathic cervical spinal subdural haematoma (SSDH) in which the haematoma was spontaneously absorbed without any treatment. A 68-year-old male patient presented with persistent neck pain and no obvious cause. Magnetic resonance imaging (MRI) revealed a space-occupying lesion at the C4–T1 levels. The lesion was initially misdiagnosed as a tumour. An operation was arranged to remove the tumour, but a preoperative computed tomography scan showed no obvious abnormal soft tissue density in the cervical spinal canal. Repeat enhanced MRI showed degeneration of the cervical vertebrae, but no obvious abnormal soft tissue density and no obvious enhanced signals in the cervical spinal canal. Spontaneous resolution of an idiopathic cervical SSDH was considered. Idiopathic cervical SSDH without obvious neurological symptoms are difficult to diagnose, so suspected cases should be carefully monitored. If the neurological symptoms grow progressively more debilitating with time, emergency surgery might need to be considered. To avoid unnecessary surgery, conservative management should be an option for patients with minimal neurological deficits and re-examination with MRI could be the best way to observe the dynamic changes taking place in the idiopathic cervical SSDH.

Delayed Posttraumatic Subacute Lumbar Subarachnoid Hematoma: Case Report and Review of the Literature

BACKGROUND

Traumatic spinal subarachnoid hematoma, associated or not with a concurrent subdural hematoma, has rarely been described. The evolution of such hematomas is heterogeneous. This study aims at defining the most accurate management, which is currently not standardized.

CASE DESCRIPTION

A 20-year-old man, victim of a high-kinetic road accident 5 days before and with several nonneurologic nonsurgical vertebral fractures, experienced a sudden dorsolumbar pain radiating to his lower limbs. A rapidly progressive asymmetric paraparesis with loss of reflexes was noticed, associated with bilateral global hypoesthesia of the lower limbs and with acute urinary retention, whereas the anal tonicity was preserved (American Spinal Injury Association C). Magnetic resonance imaging scan revealed a conus medullaris compression at the level of the L1-L2 vertebrae by an intradural expansive mass. Immediate surgical decompression revealed a strictly subarachnoid hematoma. Venous bleeding was seen at the level of the conus medullaris and controlled. Pathologic examination of the clot excluded an underlying tumor or vascular abnormality. The complete coagulation profile was normal.

CONCLUSION

Six weeks after surgery, the neurologic examination revealed only a slight tactile hypoesthesia of the left thigh. With only 4 reported cases, purely subarachnoid spinal hematomas remain widely rarer than epidural hematomas. The reported case possesses a certain number of peculiarities: young age, pure subarachnoid location, lumbar location, occurrence after a car accident, subacute onset, and excellent neurologic recovery. In our opinion, a symptomatic subarachnoid spinal hematoma should be surgically evacuated at the early phase so neurologic recovery can be expected.

Migration of innumerable chronically retained acupuncture needles

We present a case of a 50-year-old female with a 2-day history of back and abdominal pain who was discovered to have innumerable chronically retained acupuncture needles, which had migrated throughout her abdomen and pelvis. Although many of these needles were in precarious positions, including the epidural space, renal parenchyma, small bowel, and vasculature, there was no evidence for acute injury. We also briefly discuss evidence for the magnetic resonance imaging compatibility of acupuncture needles. Although a rare complication, given the high frequency of acupuncture therapy in the United States, physicians must be aware of the potential for retained and migrated needles.