Internal jugular vein fistula mimicking dural arteriovenous fistula after cardiac pacemaker placement

Carotid jugular arteriovenous fistulas are a documented complication of cannulation of the internal jugular vein. They may present with neck pain, headache, and cardiovascular aberrations. However, carotid jugular fistula secondary thrombus formation after jugular cannulation with radiographic presentation similar to dural arteriovenous fistula has not yet been reported in the literature. Below, we report the case of a 68-year-old male with an incidentally found carotid-jugular fistula secondary to pacemaker placement who had intracranial reflux on imaging, which was ultimately treated successfully through an endovascular approach.

Spinal subarachnoid hemorrhage as a consequence of dissection with pseudoaneurysm in a cervical radiculomedullary branch of the anterior spinal artery

Spinal subarachnoid hemorrhage is a rare condition, and it generally arises as a consequence of arteriovenous malformation, although more rarely can be caused by aneurysm, dissection, or pseudoaneurysm. In the following, we present a case of a 58-year-old male who while undergoing treatment for nephrolithiasis, developed persistent hypertension, refractory to his home medications, along with headache, neck pain, and unilateral ptosis and upper extremity ataxia. Initial CT scan demonstrated acute subarachnoid hemorrhage in the posterior fossa extending to the C7 level, Angiography ultimately revealed a focal irregularity compatible with dissection and 1mm pseudoaneurysm within the left anterior spinal artery radiculomedullary feeder at the C5-6 level. The patient was managed conservatively with 81mg ASA and repeat angiography revealed resolution of the lesion, in concordance with management of dissection and pseudoaneurysm of the carotid and vertebral arteries. Subarachnoid hemorrhage as a consequence of dissection and pseudoaneurysm of a cervical radiculomedullary feeder has been previously unreported in the literature.

Chronic intermittent tachycardia as a consequence of vagus nerve injury after anterior cervical discectomy and fusion: case report of a previously unreported complication

Background

The surgical approach of an anterior cervical discectomy and fusion (ACDF) navigates many important neurologic and vascular structures in the neck. More frequently reported complications are dysphagia, postoperative hematoma, cerebrospinal fluid leaks, and dysphonia.

Case description

This case report details an ACDF in a 49-year-old female with intractable neck pain and radicular symptoms. Following the procedure, she developed intermittent tachycardia at rest, which worsened with exertion.

Outcome

The cardiac workup was negative. A neck ultrasound demonstrated hypoechoic thickening of the vagus nerve, providing the diagnosis of vagus nerve injury. The patient's tachycardia has been managed with beta-blockers.

Conclusions

Although previously unreported, vagus nerve injury following ACDF is possible, causing sympathetic disruption, which can be managed with beta blockers.

Eagle syndrome causing cerebral sinus hypertension: Case report

Eagle Syndrome is a rare condition with a variety of presentations, resulting from an enlarged styloid process or calcified stylohyoid ligament. Due to the variety of presentations, diagnosis can be difficult. In this report, we present a case of ES that presented with a constellation of neurological symptoms, including headache and visual disturbance, ultimately found to be due to cerebral sinus hypertension, exacerbated by certain movements, caused by an enlarged styloid process with calcification of the stylohyoid ligament, consistent with ES. The patient underwent styloidectomy with immediate resolution of symptoms. This case report illustrates the diagnostic quandary often posed by ES and hopes to add further understanding to its presentation and diagnosis.

RESPONSE OF THE CZECH RMN NETWORK TO THUNDERSTORM ACTIVITY

Thunderstorm ground enhancement (TGE) is a phenomenon that enhances radiation background on the ground related to thunderstorm activity and charge structure of the thundercloud. On the other hand, the rise of gamma background is connected with precipitation by the washout of radon progeny from the atmosphere. In our analysis, we examined known enhancements of gamma background, previously attributed solely to radon progeny, using data from the Czech Radiation Monitoring Network (RMN) to investigate the enhancements with respect to thunderstorms and TGE phenomena. We also used radar precipitation data and data from the lightning location network to analyze their influences on the radiation background enhancement during three thunderstorm events that occurred in summer 2016 over the Czech Republic (Central Europe). We state that the RMN might have detected TGE over the Czech Republic.