Temporal Lobe Encephalocele with Epilepsy in A Young Female: An Atypical Presentation of Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is typically described in a middle-aged female and present with symptoms of headache, transient visual obscuration, photophobia, diplopia, rarely with pulsatile tinnitus. Seizure as a sole manifestation is very rare. Here we present a case of a young non-obese female with epilepsy, and imaging revealed temporal lobe encephalocele with typical imaging features of IIH. She underwent further workup, which confirmed the diagnosis of idiopathic intracranial hypertension.

Outcomes of MPFL reconstruction with tibial tubercle transfer for recurrent patellar instability with high grade trochlear dysplasia in Indian population.

BACKGROUND: Patellar instability is a painful condition which affects the quality of life and mobility of young individuals. The aim of this study is to observe the results of medial patello-femoral ligament reconstruction with hamstring autograft along with a modified Fulkerson osteotomy, for recurrent instability of patella with high-grade trochlear dysplasia in Indian population. MATERIALS & METHODS: We conducted a prospective observational study of 26 knees (21 patients) who attended our outpatient department from June 2014 to February 2019, with recurrent instability of the patella and high-grade trochlear dysplasia. All knees were treated with MPFL reconstruction with hamstring autograft and modified Fulkerson osteotomy. RESULTS: The mean follow-up period was 30 months (range: 24-50). The mean Lysholm scores improved from 49.9 (range: 30-63) preoperatively to 82.5 (range: 51-100) (p < 0.05), Kujala scores from 55.5 (36-67) to 85.9 (55-100) and International Knee Documentation Committee (IKDC) scores from 50.2 (31.6-62.3) to 82.9 (54.7-98.3) (p < 0.05) at 2 years follow-up. TT-TG distance decreased from 21.2 mm (18-25) to 11.6 mm (10-13) (p < 0.05) and patellar tilt angle decreased from 24.2° (18°-35°) to 7.2° (5°-10°) (p < 0.05). One knee had superficial skin infection in immediate post-operative period. Three knees had postoperative stiffness, which improved on manipulation under anesthesia. Six knees had implant irritation from the osteotomy screws which were removed after bony union was achieved. Functional scores were low in two knees due to patello-femoral pain, but they did not have recurrent instability. CONCLUSION: MPFL reconstruction with tibial tubercle transfer gives good functional outcomes in 92.3% patients with recurrent patellar instability, associated with high-grade trochlear dysplasia in Indian population.

Aches and Pains in a Patient With History of Prostatectomy: Extensive Skeletal Metastasis Picked up by Diffusion-Weighted Magnetic Resonance Imaging.

A 64-year-old gentleman presented to the out-patient with complaints of generalized body ache. He had a history of prostate cancer for which robotic radical prostatectomy (RP) was done earlier. The levels of prostate specific antigen (PSA) and alkaline phosphatase (ALP) were significantly elevated. Skeletal radiograph showed only few sclerotic foci. Magnetic resonance imaging whole-body diffusion-weighted image (MRI-WB-DWI) however revealed the presence of diffuse skeletal metastasis. In any elderly male who presents with generalized body pain, eliciting a good history should not be overlooked. With a history of prostate cancer, diffuse metastases should be high in the list of differential diagnosis. Though there are several imaging methods to detect metastases, MRI-WB-DWI is a welcome alternative to the established methods. Patients who undergo RP for prostate cancer should be counselled regarding the importance of follow-up of their PSA levels.

Call-Fleming syndrome.

Call-Fleming syndrome is a part of reversible cerebral vasoconstriction syndrome (RCVS) group and is thought to be of idiopathic origin. It is classically described to be having multisegmental, focal vasospasms in the cerebral arteries. It is characterized clinically by the sudden onset of severe headache, classically described as thunderclap headache, with or without associated neurological deficits. The importance of it lies in that it is a potentially reversible cause of this clinical presentation, unlike its other counterparts, aneurysmal subarachnoid hemorrhage (SAH) or vasculitis.

Nasal foreign bodies: a review of management strategies and a clinical scenario presentation.

We report a case of a toothbrush head lodged into the nasal cavity, which required an external rhinoplasty for retrieval. A review of the literature on management strategies in case of nasal foreign bodies is presented.