Optic neuropathy diagnosis in the emergency room - retrospective observational study of the last 18 years

INTRODUCTION

Optic neuropathies (ON), a broad spectrum of disorders of the optic nerve, are a frequent cause of visual loss, presenting either in isolation or associated to neurological or systemic disorders. They are often first evaluated in the Emergency Room (ER) and a rapid determination of the etiology is imperative for implementing timely and appropriate treatment. We aim to describe ER demographic data and clinical characteristics, as well as the performed imaging exams, of patients subsequently hospitalized and diagnosed with ON. Furthermore, we seek to explore the accuracy of ER discharge diagnosis and evaluate possible predictive factors that may influence it.

METHODS

We retrospectively reviewed the medical records of 192 patients admitted to the ward of the Neurology Department of Centro Hospitalar Universitário São João (CHUSJ), with a discharge diagnosis of ON. Subsequently, we selected those admitted from the ER, with clinical, laboratory and imaging data, between January 2004 and December 2021.

RESULTS

We included 171 patients. All participants were discharged from the ER and admitted in the ward with a main diagnostic suspicion of ON. Patients were stratified according to suspected etiology at the time of discharge: 99 inflammatory (57.9%), 38 ischemic (22.2%), 27 unspecified (15.8%) and 7 other (4.1%). By comparing with current follow-up diagnosis, 125 patients had an accurate ER diagnosis category (73.1%), 27 had an ON diagnosis of unspecified etiology that was defined only during follow-up (15.8%) and 19 had an inaccurate diagnosis category (11.1%). Diagnostic change was more common with ER ischemic diagnosis (21.1%) compared to inflammatory diagnosis (8.1%) (p = 0.034).

CONCLUSIONS

Our study reveals that most patients with ON can be accurately diagnosed in the ER through clinical history neurological and ophthalmological evaluation.

Pylephlebitis — a rare complication of a fish bone migration mimicking metastatic pancreatic cancer: A case report

BACKGROUND

Pylephlebitis is a rare condition, poorly recognized by clinicians and with few references. In this case, the clinical appearance resembled the clinical course of a pancreatic cancer and was originated by the ingestion of a fish bone, making the case more interesting and rare.

CASE SUMMARY

A 79-year-old female presented to the emergency department with fever, loss of appetite and jaundice. Tenderness in the right upper quadrant was present. Inflammation marker were high. A computed tomography (CT) scan revealed gallstones and aspects compatible with acute pancreatitis. The patient was admitted to surgery ward and has her condition aggravated. A magnetic resonance revealed multifocal liver lesions. Later, a cholangiopancreatography and an endoscopic ultrasound (US) were able to diagnose the condition. Specific treatment was implemented and the patient made a complete recovery.

CONCLUSION

In conclusion, this case report demonstrates for the first time the diagnosis of an unusual case of pylephlebitis complicated by the migration of a fish bone, mimicking metastatic pancreatic cancer. Clinical presentation and traditional imaging studies, such as transabdominal US and CT, remain the standard for diagnosing this condition.

Prevalência de pielonefrite aguda e incidência de cicatriz renal em crianças menores de dois anos de idade com infecção do trato urinário avaliadas por cintilografia renal com 99mTc-DMSA: a experiência de um hospital universitário

OBJETIVO: Calcular as frequências de pielonefrite aguda e cicatriz renal em pacientes menores de dois anos com cintilografia renal com 99mTc-DMSA com primeiro quadro de infecção do trato urinário em hospital universitário brasileiro, comparando com dados da literatura internacional. MATERIAIS E MÉTODOS: Foram revisados laudos cintilográficos de crianças menores de dois anos de idade que realizaram cintilografia renal com 99mTc-DMSA em um hospital universitário no Rio Grande do Sul, entre 2006 e 2009, para pesquisa de pielonefrite aguda/cicatriz renal. Revisaram-se a presença de refluxo vesicoureteral, o uso precoce de antibiótico, e a presença de comorbidades que constassem nos prontuários eletrônicos. Calculou-se a amostra com base num estudo de revisão sistemática e obteve-se um mínimo de 147 pacientes. Excluíram-se pacientes sem registro eletrônico. RESULTADOS: Cento e cinquenta e sete crianças preencheram critérios de inclusão do estudo, 48 tiveram pielonefrite aguda e 8 destas apresentaram cicatriz renal. Nem a idade nem o gênero dos pacientes apresentaram associação significativa com pielonefrite aguda (p = 0,405 e p = 0,124, respectivamente). Não houve diferença estatística nas associações de refluxo vesicoureteral e pielonefrite aguda (p = 1,0) e outras comorbidades (p = 0,470) e em relação ao uso precoce de antibiótico com pielonefrite aguda (p = 0,130) e cicatriz renal (p = 0,720). CONCLUSÃO: As frequências de pielonefrite aguda e cicatriz renal obtidas concordam com os resultados da maioria dos estudos publicados.

Cerebrospinal fluid eosinophilia associated with intraventricular shunts

CSF eosinophilia (CSF-eo) is uncommon and is usually caused by helminthic infections. However, it has also been found in ∼30% of patients experiencing intraventricular shunt malfunctions. We present a case report and review the conditions associated with CSF-eo and their prophylaxis. An 8 year-old boy with tetraventricular hydrocephalus has had several shunt malfunctions over the last three years. During hospitalization in January 2009 for shunt revision, a transient 30% eosinophilia was detected in his cerebral spinal fluid (CSF) concomitant with Staphylococcus epidermidis infection and long term vancomycin administration. After several shunt replacements and antibiotic treatment, CSF-eo eventually disappeared with good overall clinical response. CSF-eo is a transient and focal event mainly associated with infection, reactions to foreign substances, particles or blood, or obstruction of tubing by normal or fibro-granulomatous tissues. Infection associated with CSF-eo is usually caused by S. epidermidis and Propioniumbacterium acnes. In addition to infection, allergy to silicone and other foreign materials may also be a cause of CSF-eo. We review the diversity of conditions and proposed mechanisms associated with CSF-eo, as well as recommendations for the care of patients with shunts. Detection of CSF-eo has been shown to be a useful indicator of shunt malfunction. As such, it provides physicians with an indicator of a hypersensitivity reaction that is underway or the need to identify bacterial infection. We also highlight the need for improved biocompatibility of shunt hardware and describe strategies to avoid conditions leading to shunt malfunction.

The challenge of managing fusiform basilar artery aneurysms: from acute ischemic stroke to a massive subarachnoid hemorrhage

We present the case of a patient with acute brain stem ischemic stroke who was found to have a fusiform basilar aneurysm with a thrombus within the dilated vessel. Three days after the ischemic stroke, the patient had a massive subarachnoid hemorrhage and died. This case illustrates the difficulties in the acute management of ischemic events in patients with basilar fusiform aneurysms, because the natural history of this disease encompasses both bleeding and thrombosis.

Oral conditions in children from birth to 5 years: the findings of a children's dental program

The study aimed to assess oral conditions other than caries and gingival inflammation present in the mouth of children from birth to 5 years old attending a Community Dental Program. Data were collected through the examination of all dental records, who attended the clinic from November 1997 until November 1999. A total of 1042 records were examined. The results showed that 97.7% of the patients had no lesions present in the mouth during the visits to the clinic, while 2.3% who presented did have lesions. The conditions most frequently found were: Bohn's nodules, candidiasis and benign migratory glossitis.

Visual modelling

The first purpose of this paper is to present a neural net model of the visual cortex of higher vertebrates based on the electrophysiological properties of the ganglion cells. This model takes Hebb's law [1] as the physiological learning rule for synaptic modification. The model consists of 85 x 85 neurons forming a layer similar to the cortex. The neurones are massively connected via weights that are typically adapted. We simulate several input patterns and show that the model reproduces the pattern recognition, contours pictures and moving perception.