Correction: Posterior Reversible Encephalopathy Syndrome in the Immediate Postoperative Period of Gastric Cancer.

[This corrects the article DOI: 10.7759/cureus.49388.].

Posterior Reversible Encephalopathy Syndrome in the Immediate Postoperative Period of Gastric Cancer.

A 55-year-old female was referred to the Department of Ophthalmology with complaints of bilateral loss of vision. She had undergone subtotal gastrectomy with gastrojejunostomy and lymphadenectomy for poorly differentiated gastric adenocarcinoma in the antropyloric region the day before. On the first postoperative day, she complained of generalised weakness, drowsiness, altered sensorium, and acute, painless, bilateral loss of vision. Ocular examination revealed visual acuity as no perception of light, bilaterally, and normal pupillary light reflexes. Anterior and posterior segment examination was within normal limits. This clinical presentation of altered sensorium and cortical blindness along with characteristic radiological findings (hyperintensity on T2/fluid-attenuated inversion recovery sequence involving the bilateral parieto-occipital lobe extending in asymmetric fashion to the bilateral cerebellum, brainstem, and thalami predominantly involving the white matter with few areas of diffusion restriction on diffusion-weighted imaging sequence predominantly on the left side with gyriform pattern) confirmed the diagnosis of posterior reversible encephalopathy syndrome (PRES). In cancer patients, PRES has been reported in patients on chemotherapy regimen or two weeks after surgery for gastric cancer. Here, we want to draw attention to the fact that PRES may develop in the immediate postoperative period of gastric cancer surgery, as seen in our case.

Differentiation between various types and subtypes of intracranial meningiomas with advanced MRI.

Background: Meningiomas are the most prevalent of all intracranial tumours. Although they are mostly benign, about 20% of meningiomas are atypical or malignant. Knowledge of their histologic grade can be clinically useful while planning surgery. Objectives: To differentiate between various grades and subtypes of meningiomas with advanced MR parameters. Method: We assessed the advanced MR imaging characteristics of 27 histopathologically confirmed meningiomas on a 3T MRI, of which 23 were grade I meningiomas (2 fibroblastic, 9 meningothelial, 9 transitional, 3 unspecified) and 4 were grade II/III meningiomas (2 atypical, 1 papillary, 1 anaplastic). Analysis of the ADC, FA, λ1, λ2, λ3 and mean diffusivity was performed using standard post-processing software. Results: The mean size of atypical meningiomas (5.9 cm ± 0.7 cm) was significantly higher (p = 0.038, 95% confidence interval [CI]) than that of typical meningiomas (4.6 cm ± 1.6 cm) with a cut-off value of 6.05 cm (75% sensitivity and 87% specificity). The mean cerebral blood flow (CBF) (ASL) of atypical meningiomas (286.70 ± 8.06) was significantly higher (p = 0.0000141, 95% CI) than that of typical meningiomas (161.09 ± 87.04) with a cut-off value of 276.75 (66.7% sensitivity and 75% specificity). Among the typical meningiomas, transitional subtypes had the lowest ADC. High FA and planar coefficient (CP) values and low λ3 and spherical coefficient (CS) values were seen in fibroblastic meningiomas. Fibroblastic meningiomas also showed the lowest vascularity among typical meningiomas. Conclusion: Tumour size and ASL perfusion are two parameters that could differentiate between typical and atypical meningiomas while ADC, FA, λ3, CP, CS, rCBF and rCBV may be helpful in distinguishing different subtypes of typical meningiomas.

Mycobacterium kansasaii and Mycobacterium scrofulaceum dual pulmonary infection in an immunocompetent male: first report from India.

A 57-year-old farmer presented with chronic cough and recurrent hemoptysis, previously treated for sputum positive pulmonary tuberculosis. Referred to us for evaluation of drug resistant tuberculosis as his sputum was persistently positive for acid fast bacilli along with radiological worsening even after 6 months of antitubercular treatment. Bronchoalveolar lavage was done and he was diagnosed with a rare mixed non-tuberculous mycobacyteria (NTM) pulmonary infection despite no immune dysfunction. He was successfully treated with multidrug regimen of rifampicin, isoniazid, ethambutol and clarithromycin.

Diagnosing Joubert Syndrome in Two Adult Siblings: A Very Rare Case Report.

Joubert syndrome (JS) is a rare genetic disorder usually diagnosed during childhood. Adult Joubert syndrome is rare, and that too in siblings from a non-consanguineous marriage in their adulthood is extremely rare, with very few cases reported worldwide. The need for expensive imaging modality to aid diagnosis has also been cited as a drawback in diagnosing the condition in resource-poor areas. We describe the case of two adult siblings who came for other diseases and were diagnosed with Joubert syndrome.

Tuberculous Skull Base Osteomyelitis With Cerebral Venous Sinus Thrombosis in an Immunocompetent Adolescent: A Case Report.

Skull-base osteomyelitis is a rare yet lethal entity. It is infrequently observed among immunocompetent children and young adults, and Mycobacterium is much less common among the various bacterial and fungal etiological causes noted. We report a rare case of a 17-year immunocompetent girl who presented with complaints of head and neck pain and restricted neck movements. The analysis of her cerebrospinal fluid revealed a lymphocytic pleocytosis with elevated protein levels. Imaging studies revealed erosion of the occipital condyle and clivus and an extradural collection extending into the prevertebral and paravertebral spaces until the second cervical vertebra level. In addition to this life-threatening complication, the potential involvement of the cerebral venous sinuses is also of particular interest-a diagnosis of tubercular meningitis with skull base osteomyelitis based on the CSF and imaging findings. The drastic improvement in the initiation of anti-tubercular therapy emphasizes the need for prompt and early initiation of anti-tubercular therapy in endemic areas. The clinical picture, diagnosis, and treatment of tubercular skull-base osteomyelitis are further discussed, and pertinent literature has been reviewed.

Prediction of Preeclampsia Using First-Trimester Uterine Artery Doppler and Pregnancy-Associated Plasma Protein-A (PAPP-A): A Prospective Study in Chhattisgarh, India.

Introduction Preeclampsia is a major contributor of maternal and perinatal morbidity and mortality. Uterine artery waveform and biomarkers like pregnancy-associated plasma protein-A (PAPP-A) may reflect the pathophysiology of preeclampsia. Thus, we aim to find out whether abnormal uterine artery pulsatility index (PI) and low serum PAPP-A in the first trimester can predict preeclampsia. Methodology Antenatal women at 11-13+6 weeks of gestation visiting All India Institute Of Medical Science (AIIMS) in Raipur were enrolled after informed consent. Uterine artery Doppler was done with the early anomaly scan at 11-13+6 weeks. Serum levels of PAPP-A were analyzed. The women were followed up at intervals up to delivery. Incidence of preeclampsia and gestational hypertension was noted. Results The incidence of preeclampsia was 12.7%, and that of gestational hypertension was 4.9%. The mean uterine artery PI among those who developed hypertension in pregnancy was 2.007, which was significantly higher than the unaffected group (p=0.01). The first-trimester uterine artery PI as a screening tool showed a sensitivity of 68%, specificity of 52.99%, and detection rate (DR) of 55.63%. The mean PAPP-A MoM of the affected group was 0.67 which was significantly higher than the unaffected group (p<0.001). The first trimester PAPP-A as a screening tool showed a sensitivity of 28%, specificity of 90.6%, and DR of 79.58%. Conclusion Both the tests were concluded to be good predictors of hypertension in pregnancy. Identification of high-risk factors, screening, and surveillance are of utmost importance in order to predict preeclampsia and initiation of preventive therapy.

Effect of Exogenous Progesterone on Fetal Nuchal Translucency: An Observational Study.

Introduction Nuchal translucency is a reliable first trimester screening test for fetal structural and chromosomal defects. Neonates with increased nuchal thickness are at greater risk for anomalies. Exogenous progesterone supplementation may affect nuchal translucency and thus the first trimester anomaly screening. We aimed to study if there was a difference in nuchal thickness between women receiving progesterone in the first trimester compared to those who were not supplemented with progesterone. Material and methods Forty-seven women with documented progesterone intake in the first trimester for at least 10 continuous days before the day of the nuchal translucency scan served as the study group compared to 47 other women who did not receive progesterone. Nuchal translucency was measured between 11 and 13 weeks and six days of gestation. Results The mean nuchal translucency increased with increasing gestation in both groups. Maximum mean nuchal translucency was greatest in the age group 18-20 years (1.35 + 0.1 millimeters) in women receiving progesterone compared to 36-40 years (1.65 + 0.49 millimeters) in controls. The mean nuchal translucency in women receiving progesterone was 1.15 + 0.26 millimeters, and in those that did not receive progesterone, it was 1.23 + 0.35 millimeters (p = 0.314). Conclusions Nuchal translucency increased with increasing gestation in both groups, irrespective of progesterone supplementation. There was no significant difference in mean nuchal translucency in women supplemented with progesterone compared to those that did not receive progesterone in the first trimester.

Osteopetrosis in a Patient of Systemic Sclerosis Sine Scleroderma: A Rare Association.

Systemic sclerosis is a connective tissue disorder of unknown etiology. Although it is a multisystemic disorder, skin thickening is considered as a hallmark of the disease. It usually involves the lungs, gastrointestinal, and musculoskeletal systems. However, a rare subset of systemic sclerosis, systemic sclerosis sine scleroderma, is characterized by internal organ involvement and positive serologic markers with the total or partial absence of cutaneous manifestations. We present a rare association of osteopetrosis in a case of systemic sclerosis sine scleroderma, in a 22-year-old male patient, who presented with pulmonary symptoms as his chief complaints, unreported so far in literature.