Dorsal medullary cavernous hemangioma presenting as obstinate hiccups and its surgical treatment: illustrative case.

BACKGROUND: Hiccups are characterized by involuntary, intermittent, repetitive, myoclonic, and spasmodic contractions of the diaphragm. Hiccups are termed "intractable" when they last for over 1 month. OBSERVATIONS: A rare case of intractable hiccups due to an uncommon location of cavernous hemangioma in the dorsal medulla is illustrated. With respect to the management, surgical excision was performed, and postsurgical complete recovery was witnessed, which has been reported only in six cases worldwide to date. LESSONS: A mechanism of the hiccups reflex arc is discussed in detail with special reference to the need for equal emphasis on evaluating central nervous system causes and peripheral etiologies for pertinent hiccups.

A rare case of intramedullary tuberculosis with paraparesis.

Intramedullary tuberculoma (IMT) is considered to be a rare form of spinal tuberculosis (TB). Overall, TB of the central nervous system accounts for approximately 1% of all cases of TB and 50% of these involve the spine. The clinical presentation of spinal intramedullary TB is similar to an intramedullary spinal cord tumor mass. The factors attributable could be malnutrition, poor socioeconomic conditions, and immunodeficiency syndromes. As per the reports, the incidence of primary intramedullary TB is 2 in 100,000 cases among patients with TB. We describe one such patient who presented with progressive asymmetrical paraparesis due to histologically confirmed intraspinal tuberculoma. Paraparesis in spinal IMT is considered to be rare. Hereby, we present the case of a 29-year-old female who presented with asymmetric onset paraparesis of 6 months with associated numbness and tingling began in the left foot 3 months which was ascending in nature. There was no history of stiffness, involuntary movements, flexor spasms, thinning, or fasciculations of muscles. There was a loss of sensation pain, touch, and temperature below L3 with normal reflexes. Power in both the lower limbs was 1/5 as per Medical Research Council (MRC) grading. She underwent a contrast magnetic resonance imaging spine which was suggestive of an intramedullary SOL at D12 vertebral level. The patient underwent surgical intervention with resection of the SOL. Histopathology was confirmed to be an IMT. She was started on Category 1 (antitubercular drugs) and further investigated for primary source, which was found to be negative. We want to emphasize that TB can involve any part of the body. It should be kept as a differential diagnosis of any chronic inflammatory lesion involving the bony skeleton, especially in endemic countries where combined surgical and medical treatment is usually sufficient to provide a cure.

A rare case of calvarial tuberculosis in post-COVID-19 scenario.

Isolated calvarial involvement with tuberculosis (TB) is a very rare entity, with the incidence of only 0.01% of all patients with mycobacterial infections. The factors attributable could be malnutrition, poor socioeconomic conditions, and immunodeficiency syndromes. We hereby present the case of a 35-year-old male who had recently recovered from coronavirus disease 2019 and a diagnosed case of Evan's syndrome with secondary hemophagocytic lymphohistiocytosis who presented with a scalp swelling on the right frontotemporal region. He presented to the emergency department with acute-onset generalized tonic - clonic seizures with high-grade fever. Clinically, the swelling appeared like a cystic swelling of the scalp. On evaluation, there was a collection present below the scalp communicating with the extradural space, involving the underlying skull bone. The patient was operated with drainage of the abscess plus excision of the pathological underlying skull bone. The pus revealed florid amount of acid-fast bacillus on Ziehl-Neelsen staining. The patient was started on four drugs Category 1 antitubercular regimen. The patient responded well to the combined surgical and medical treatment. It should be emphasized that TB can involve any part of the body. It should be kept as differential diagnosis of any chronic inflammatory lesion involving the bony skeleton, especially in endemic countries where combined surgical and medical treatment is usually sufficient to provide a cure.

Vertebral Pneumatocyst-A Systematic Review.

BACKGROUND: Intraosseous pneumatocyst refers to gas-filled cystic lesions inside bone. Whereas ilium and sacrum are the commonest locations for pneumatocysts, vertebral pneumatocysts are rare. Various theories have been proposed to explain the etiopathogenesis of vertebral pneumatocysts and the most widely accepted theory is the extension of air from intervertebral disc or joint spaces into the pneumatocyst cavity. The aim of this systematic review was to study all the cases of vertebral pneumatocyst reported in the literature to understand this rare disease and its clinical importance. METHODS: A comprehensive search of the PubMed, Embase, and Scopus databases was performed to retrieve case reports and case series describing the cases of pneumatocyst. RESULTS: A total of 61 cases of incidentally reported vertebral pneumatocyst were included in the systematic review. The mean age of the patients was 57.82 ± 10.2 years (range, 31-89 years). The mean size of the pneumatocysts was 8.67 ± 4.18 mm (range, 2-20 mm). CONCLUSIONS: The prevalence of pneumatocyst increased with increasing age, with most of the reported patients belonging to the 50-70 years age-group. Most of these patients have large pneumatocysts with degenerative changes in spine. Another less common subset of young patients with small pneumatocysts without associated degenerative changes has also been described. Pneumatocysts were most common in the cervical spine, with C5 being the most commonly affected vertebra. Most of the pneumatocysts remain stable in size on follow-up, although 3 cases of enlarging pneumatocyst have also been reported. An enlarging pneumatocyst should be closely followed up, although its benign nature has been reported in the literature.

Enlarging cervical vertebral pneumatocyst - A case report.

Intraosseous pneumatocyst refers to gas-filled cystic lesions inside bone. Vertebral pneumatocysts are rare and most have been described to remain static over time. We report a rare case of an enlarging spinal pneumatocyst. A 58-year-old male patient with cervical ossified posterior longitudinal ligament with two cervical vertebral pneumatocysts (C4 and C5). The C5 cyst (9.91 × 5.9 × 4.3 mm) was larger than the C4. MRI was suggestive of compression at C4-5 and C5-6 level. Repeat imaging done eight months later showed an increase in the size of the C5 pneumatocyst (12.41 × 7.6 × 6.3 mm). In view of the enlarging pneumatocyst, patient underwent C5 corpectomy. Histopathological examination of the cyst wall revealed fibro-collagenous tissue with histiocytes and foreign body giant cells confirming the benign nature of the disease. This case highlights the importance of radiological follow up of a pneumatocyst.

"An unusual presentation of colonic mucormycosis mimicking carcinoma colon- a surgeon's perspective".

INTRODUCTION: Mucormycosis caused by order mucorales, an ubiquitous saprophytic mold found in soil and organic matter worldwide, is a rare but invasive opportunistic fungal infection. Gastrointestinal mucormycosis is the most uncommon clinical presentation being particularly rare, accounted for 4-7% of all cases. PRESENTATION OF CASE: We report an unusual presentation of mucormycosis of ascending colon that was simulating carcinoma colon. DISCUSSION: GI mucormycosis most commonly involves the stomach (57.5%), followed by the colon (32.3%) and the ileum (6.9%). Initial presentations may be abdominal pain and distension, fever, and diarrhoea. Colonic mucormycosis presenting as a mass with altered bowel habit, melena and abdominal pain in our case is extremely difficult to differentiate it from carcinoma colon. A definitive diagnosis of mucormycosis is almost always ascertained by histopathological evidence of fungal invasion of tissue. CONCLUSION: Knowing these unusual presentations of this disease, surgeon need to maintain a high index of suspicion and perform timely and appropriate diagnostic evaluation to improve patient outcome. Prompt diagnosis, reversal of predisposing conditions, and aggressive surgical debridement remain cornerstones of therapy for this deadly disease.