Low pressure headache and cerebral fat embolism from a sacral fracture through a Tarlov cyst: a case report.

BACKGROUND: Here we report the only formally documented case in the United Kingdom, to our knowledge, of a cerebral fat embolism secondary to non-iatrogenic trauma through a Tarlov cyst. This case demonstrates the pathology clearly giving an excellent opportunity to demonstrate a rarely seen pathology as well as illustrating the importance of the patient history to guiding further management. CASE PRESENTATION: A middle-aged patient was admitted on the acute medical take complaining of severe headache with photophobia, having just returned after a skiing holiday. Computerised tomography scan of the head showed fat within the anterior horn of both lateral ventricles, and within the subarachnoid space. Re-discussion with the patient and subsequent MRI (Magnetic Resonance Imaging) of the spine identified the pathogenesis of her symptoms: a sacral insufficiency fracture through a Tarlov cyst, causing subarachnoid fat embolism and symptoms of a low-pressure headaches due to a dural leak. Patient was medically managed and discharged with planned follow-up. Due to the Coronavirus pandemic and resolution of the patient's symptoms, they declined further follow up imaging. CONCLUSIONS: The case demonstrates a rarely seen pathology as cause of a common presenting problem, headache. Emphasizing the importance of history taking and appropriate investigations in medical cases that do not conform to the usual diagnosis.

The Destructive Power of Circumstance on Concurrent Poliomyelitis and Osteomyelitis.

INTRODUCTION: The current method in dealing with pediatric hip pathologies is to avoid joint replacement unless absolutely necessary. This decision is typically made on a scientific basis. However, this is not necessarily the correct approach in all cases as demonstrated in the following case report where social issues is an extremely important variable to be considered when deciding on surgical intervention. CASE REPORT: This case report is the first of its kind to highlight the pathology mentioned and the social determinants that were a causative agent in its development. This case revolves around a 46-year-old Caucasian gentleman who presented in clinic enquiring about the possibility of a hip arthroplasty. He aimed to improve his ability to work after the cessation of state benefits. A retrospective look at his history indicated a number of social factors lead to poor outcomes and the resulting downward spiral causing his current presentation. The effect of social circumstances on the medical and surgical outcomes is highlighted in this report with a look into avascular necrosis and resulting natural arthrodesis. Both of these presentations were secondary to chronic and untreated childhood osteomyelitis of the right hip in conjunction with poliomyelitis development. The dual involvement of poliomyelitis and osteomyelitis to the hip joint no doubt had a massive impact on final pathology and is a rarely documented phenomenon. From an early age, this patient has faced difficulties integrating in society by factors that were out of his control. By the time he was old enough to lead an independent life, the damage had been inflicted both medically and psychologically through his earlier ordeals. CONCLUSION: By writing this up, it is hoped that clinicians will recognize the debilitating holistic effect that mechanical joint pathologies and neurological deficiencies can have on patients' lives with the view to reopen the discussion on when it is appropriate to surgically intervene in hip pathologies in children and especially where osteomyelitis and poliomyelitis are involved.