Evaluation of subjective anterior disc space widening on trauma cervical spine CT as a potential sign of ligamentous injury.

INTRODUCTION: MRI is commonly accepted as the gold standard imaging technique for identification of isolated discoligamentous injury to the cervical spine. Widening of the anterior disc space (ADW) has been suggested as signs of injury to the anterior longitudinal ligament (ALL). The purpose of this study aimed to assess the accuracy of ADW reported on CT as a sign of ligamentous injury compared. METHODS: The study was performed at a level 1 trauma centre. All patients over a 5-year period from 1 January 2015 to 31 January 2019 who underwent a cervical CT scan for the indication of trauma and who subsequently received a cervical spine MRI during the same admission were included if no fracture was found on the initial CT. Demographic data were collected along with mechanism of injury and time period between CT and MRI. Presence or absence of subjective CT-ADW along with presence or absence of ALL injury on MRI was recorded by retrospective review of the radiology reports. Sensitivity, specificity and positive and negative predictive values were then calculated. RESULTS: Over a 5-year period, 1,305 patients fulfilled the study criteria. CT-ADW had a sensitivity, specificity and positive predictive value of 8.2% (95% CI: 2.7-18.1%), 96.2% (95% CI: 95.3-97.4%) and 10.2% (95% CI: 3.4-22.2%) respectively. CONCLUSION: Subjective CT-ADW is a poor predictor of ALL injury as assessed by MRI and should not be relied upon in isolation to diagnose ligamentous injury of the cervical spine in the setting of trauma.

Disseminated intraosseous Kaposi's sarcoma: A rare manifestation of HIV/AIDS.

Kaposi Sarcoma (KS), a mucocutaneous cancer that most frequently occurs in the context of Acquired Immunodeficiency Syndrome (AIDS) secondary to Human Immunodeficiency Virus (HIV), is a relatively benign condition, acting more as a marker of immunodeficiency than directly causing harm itself. However, it has been known to spread both locally and in a metastatic fashion, with reports of KS affecting almost all organ systems. One of the most rarely reported areas of involvement is the musculoskeletal system, with secondary osseous spread representing an even smaller subset of these. We report a case of biopsy proven disseminated intraosseous KS involving the entire imaged skeleton that occurred with HIV/AIDS, despite maximal treatment and normal imaging 8 months prior.

Accuracy of dual bolus single acquisition computed tomography in the diagnosis and grading of adult traumatic splenic parenchymal and vascular injury.

INTRODUCTION: Dual Bolus Single Acquisition Computed Tomography (DBSA-CT) has been advocated for use in trauma imaging through its ability to concurrently optimise abdominal arterial and visceral parenchymal enhancement while minimising scan times and radiation dose. However, concerns have been raised regarding excessive splenic parenchymal heterogeneity using this technique. The purpose of this study is to establish and compare the accuracy of DBSA-CT to traditional sequential multiphase scanning techniques in the diagnosis and grading of traumatic adult splenic injury. METHODS: All patients diagnosed with a traumatic splenic parenchymal and/or vascular injury using DBSA-CT at a Level 1 trauma centre, who then proceeded to Digital Subtraction Angiography (DSA) or surgery were used for analysis over the time period June 2014 to March 2016. Two consultant radiologists each independently retrospectively reviewed all CT examinations documenting the degree of splenic heterogeneity, splenic injury grade using the American Association for the Surgery of Trauma (AAST) system and presence of vascular injury. Individual radiologist accuracy and inter-observer variability were evaluated. RESULTS: Splenic parenchymal enhancement was diagnostic in all cases with, at worst, moderate splenic heterogeneity. CT AAST parenchymal injury grading correlated poorly with operative findings. Average radiologist diagnostic sensitivity was 50.0% and 38.9% for active arterial haemorrhage and pseudoaneurysm, respectively, when correlated with DSA findings. Inter-observer agreement ranged from moderate to excellent in all cases. CONCLUSION: Dual Bolus Single Acquisition Computed Tomography may lead to reduced radiologist accuracy in the diagnosis of splenic injury, particularly pseudoaneurysm; however, such conclusions remain tentative given the small patient numbers examined.

Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma.

Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

Spinal subarachnoid hemorrhage secondary to rupture of an isolated radicular artery aneurysm.

Aneurysmal subarachnoid hemorrhage (aSAH) of spinal origin is an uncommon entity and comprises less than 1% of all aSAH. The paucity of clinical cases creates challenges to its diagnosis and management. We present the case of a 58-year-old male, who presented with a spinal subarachnoid hemorrhage secondary to a de novo spinal radicular artery aneurysm. Spinal subarachnoid hemorrhages typically occur secondary to arteriovenous malformations or arterial wall weakness seen in collagen vascular disease. Fewer than 20 cases of isolated spinal arterial aneurysms have been published. SAHs of spinal origin are exceedingly rare and thus a high index of suspicion is required for an accurate and timely diagnosis.

Systemic immunity influences hearing preservation in cochlear implantation.

HYPOTHESIS: To determine whether a systemic immune response influences hearing thresholds and tissue response after cochlear implantation of hearing guinea pigs. METHODS: Guinea pigs were inoculated with sterile antigen (Keyhole limpet hemocyanin) 3 weeks before cochlear implantation. Pure-tone auditory brainstem response thresholds were performed before implantation and 1 and 4 weeks later. Dexamethasone phosphate 20% was adsorbed onto a hyaluronic acid carboxymethylcellulose sponge and was applied to the round window for 30 minutes before electrode insertion. Normal saline was used for controls. Cochlear histology was performed at 4 weeks after implantation to assess the tissue response to implantation. To control for the effect of keyhole limpet hemocyanin priming, a group of unprimed animals underwent cochlear implantation with a saline-soaked pledget applied to the round window. RESULTS: Keyhole limpet hemocyanin priming had no significant detrimental effect on thresholds without implantation. Thresholds were elevated after implantation across all frequencies tested (2-32 kHz) in primed animals but only at higher frequencies (4-32 kHz) in unprimed controls. In primed animals, dexamethasone treatment significantly reduced threshold shifts at 2 and 8 kHz. Keyhole limpet hemocyanin led to the more frequent observation of lymphocytes in the tissue response to the implant. CONCLUSION: Systemic immune activation at the time of cochlear implantation broadened the range of frequencies experiencing elevated thresholds after implantation. Local dexamethasone provides partial protection against this hearing loss, but the degree and extent of protection are less compared to previous studies with unprimed animals.