Thrombolytic therapy at systemic lupus onset with secondary antiphospholipid syndrome. A rare stroke experience.

Strokes are a major cause of disability in systemic lupus erythematosus (SLE). Classical neurological manifestations are rare at onset. The use of thrombolytic therapy improves clinical outcome in eligible stroke patients who present early. Modern imaging modalities augment decision making. This 37-year-old woman presented with an acute stroke with National Institute of Health stroke scale 10. The CT showed a hyperdense middle cerebral artery (MCA) dot sign. The magnetic resonance angiography revealed focal thromboembolic occlusion at the insular MCA segment (M2). Intravenous recombinant tissue plasminogen activator (rtPA) was administered with successful recanalization. The present case was a rare event for rtPA use in acute MCA occlusion with underlying latent lupus. Acute vascular event thrombolysis as the presenting manifestation of autoimmune disease has not previously been encountered on literature review. Stroke pathophysiology in conditions of hypercoagulability is a significant clinical entity where the implication for thrombolytic use requires further studies. An ischemic stroke with underlying connective tissue disease benefits from timely multimodal brain imaging and should be considered for reperfusion.

Testicular Ectopia in the Anterior Abdominal Wall of a Neonate: A Rare Site of Ectopic Testis.

BACKGROUND Abnormal testicular descent can either be undescended or, less commonly, ectopic. Most undescended testes complete the course of descent by the first year of life only if these remain in the normal path of descent. The deviation of the testis may occur to an ectopic location during the transinguinal phase. Of the known ectopic sites, the anterior abdominal wall is the rarest site of testicular ectopia and to our knowledge only 3 cases of this nature have been reported in the available literature to date.  CASE REPORT This rare case of testicular ectopia occurred in a 3-day-old boy in whom the right scrotal sac was empty; on abdominal ultrasound, the right testis was found in the subcutaneous tissues of the right antero-lateral abdominal wall. These findings were confirmed on abdominal MRI, where the right testis was seen beneath the skin between the subcutaneous tissues and external oblique aponeurosis. No aponeurotic or muscular defect was appreciable under the abdominal wall. The neonate underwent orchiopexy at the age of 6 months and remained uneventful postoperatively. CONCLUSIONS Preoperative imaging is recommended to detect and confirm the ectopic site as well as the morphology of testis, thereby increasing the chance of surveillance and preservation of an ectopic testis. Imaging can serve as preoperative road mapping to localize the exact site for surgical exploration of an ectopic testis if there is no apparent or palpable swelling over the anterior abdominal wall.