An Aberrant Case of Neuromyelitis Optica Spectrum Disorder With a Review of Literature.

Neuromyelitis optica spectrum disorder (NMOSD) is a rare, acquired demyelinating condition predominantly affecting middle-aged women and is characterized by spinal cord inflammation and optic neuritis. Anti-aquaporin 4 (AQP4) antibodies are typically seen in NMOSD. However, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) shares clinical and imaging similarities. In NMOSD, longitudinally extensive spinal cord lesions (LESCLs), optic neuritis predominantly affecting the posterior aspect of optic nerves, and optic radiations are seen on magnetic resonance imaging (MRI). The brain parenchymal lesions particularly involve the dorsal medulla (area postrema). The report presents a case of a 26-year-old female with recurrent episodes of weakness, pain, and sensory symptoms in both upper and lower limbs who was initially treated for multiple sclerosis. Upon experiencing new symptoms of blurred vision and ataxia, an MRI of the spine and brain was performed, which showed short-segment cervical cord involvement and a lesion in the conus medullaris, raising the suspicion of NMOSD. Subsequent antibody testing confirmed the presence of anti-AQP4 antibodies. While the involvement of the conus medullaris is classically associated with MOGAD, unusual findings in the present case highlight the importance of comprehensive imaging evaluation and raising awareness among clinicians and radiologists regarding the imaging spectrum of NMOSD, thus facilitating timely diagnosis and tailored treatment strategies.

Diagnostic Accuracy of Hounsfield Unit Value and Hounsfield Unit to Hematocrit Ratio in Predicting Cerebral Venous Sinus Thrombosis: A Retrospective Case-Control Study.

OBJECTIVE: Non-contrast computed tomography (CT) of the brain is a primary neuroimaging modality in emergency patients suspected of having cerebral venous sinus thrombosis (CVST). The objective of the study was to determine the diagnostic accuracy of Hounsfield unit (HU) values and the ratio of HU to hematocrit value (HU/Htc) in predicting CVST in suspected patients. MATERIAL AND METHODS: A retrospective, case-control study was done in a tertiary care institute which included 35 patients with CVST constituted as cases and 41 patients without CVST as controls on the basis of magnetic resonance venography (MRV). Non-contrast CT brain of all 76 subjects were assessed by two experienced radiologists independently. HU values of dural venous sinuses were calculated in both groups, and HU/Htc ratio was also determined. Statistical Package for Social Sciences (SPSS) version 25.0 (SPSS© for Windows, IBM© Corp.) was used for statistical analysis. Independent samples t-test was applied to compare the means of continuous variables. The diagnostic values were computed using the Calculator 1 tool on clinical research calculators tab on vassarstats.net. The predictive values of HU and HU/Htc ratio were estimated by the receiver operating characteristic (ROC) curve analysis. RESULTS: In CVST group, the mean Hounsfield Unit (HU) value was "75.9±3.9 (mean±SD)", while in control group, it was 57.78±4.65 (mean±SD), p < 0.001. The mean HU/Htc ratio was 1.98±0.42 (mean±SD) in the CVST group and 1.51±0.12 (mean±SD) in the control group (p < 0.001). Optimum cut-off HU value was calculated as 68, with 97% sensitivity and 100% specificity. For HU/Htc ratio, optimum cut-off was calculated as 1.69, yielding 71.4% sensitivity and 100% specificity on the basis of ROC curves. The difference was not statistically significant in hemoglobin and hematocrit (Htc) values between the cases and controls. CONCLUSION: The quantitative measurements like HU value and HU/Htc ratio provide an easily obtainable metric in patients with suspected CVST on non-contrast CT brain, thus enhancing the role of non-contrast CT brain in diagnosing CVST.

Bilateral Renal Cell Carcinoma in the Horseshoe Kidney With Metastasis in Gallbladder, Pancreas and Duodenum: A Report of a Rare Case and Literature Review.

Horseshoe kidney is the most common renal fusion anomaly and is associated with various complications, ranging from infections to neoplasms. While renal cell carcinoma (RCC) is the most frequent renal neoplasm in adults, its occurrence in a horseshoe kidney is rare, and bilateral involvement is rarer. Furthermore, RCC metastasizing to organs is known and rare sites of metastasis are also documented. The report presents a unique case of bilateral RCC in a horseshoe kidney with synchronous metastasis to the gallbladder, pancreas, and duodenum. This presentation, involving metastasis to these specific organs, is exceedingly uncommon, making it a rarest of rare possibilities. The current case report underscores the importance of vigilant monitoring and comprehensive evaluation in patients with horseshoe kidneys, as they may be predisposed to unusual complications like RCC and rare site metastasis.

Comparison of Dynamic Magnetic Resonance Defecography With Clinical Examination in Diagnosing Pelvic Floor Dysfunction: An Observational Study.

BACKGROUND: Pelvic floor dysfunction (PFD) is frequently reported in both sexes. Dynamic magnetic resonance defecography (DMRD) is the preferred modality, mainly due to its superiority and complementary role in clinical examination. However, studies from the perspective of Indian patients are scarce and mostly restricted to females. Thus, we assessed the diagnostic performance of DMRD in patients with PFD and correlated the findings with those on clinical examination. MATERIALS AND METHODS: This prospective, observational study involved 57 adult patients of either sex, presenting with pelvic floor symptoms (PFS) and diagnosed with PFD. Initially, the patients underwent clinical examination, and diagnosis was recorded. Subsequently, the patients were subjected to DMRD. The findings were correlated with the Pearson "r" correlation coefficient. RESULTS: A significantly greater proportion of patients had involvement of multiple compartments (36 vs. 12, p<0.001), cystocele (23 vs. 8, p=0.002), and rectal prolapse (25 vs. 14, p=0.030) on DMRD than clinical examination, while there was no significant difference regarding uterine prolapse (p=0.789). Grading of cystocele and rectal prolapse as well as diagnosis of enterocele/peritoneocele, rectocele, and intussusception could be done only with DMRD. DMRD had a strong and significant correlation with clinical examination regarding cystocele (r=0.943, p=0.003), uterine prolapse (r=0.972, p=0.001), and rectal prolapse (r=0.951, p=0.001). CONCLUSIONS: DMRD demonstrated significantly better performance in the diagnosis of multiple compartment involvement, cystocele, and rectal prolapse. DMRD and clinical examination were significantly correlated regarding the diagnosis of cystocele, uterine prolapse, and rectal prolapse. Thus, DMRD provides information, in addition to the clinical examination, and should be used in symptomatic patients.

Utility of Doppler ultrasound in early-onset neonatal sepsis.

BACKGROUND: Neonatal sepsis is an important cause of morbidity and mortality among newborns. As there is paucity of literature regarding early alteration of the cerebral blood flow (CBF) in neonatal sepsis our study aims to evaluate the changes in the CBF velocities and Doppler indices in neonates with early-onset neonatal sepsis (EONS) and to evaluate the predictive accuracy of cerebral blood flow velocities (CBFV) by using ultrasound Doppler as a diagnostic marker of EONS. METHODS: This cross-sectional analytical study was conducted over a period of 2 years with 123 neonates enrolled in the study. The neonates were divided into two groups: Group I (with 54 neonates) - neonates with EONS and group II (with 69 neonates) - age-matched neonates without any signs of sepsis. Ultrasound Doppler examination was performed and the cerebral hemodynamics assessed in neonates during the first seventy two hours of life. Doppler indices and CBFV were measured in the internal carotid artery (ICA), middle cerebral artery (MCA), and vertebral artery (VA) of either side. Data were analyzed using the statistical program SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated at different selected cutoff values for CBFV parameters. RESULTS: Lower resistance and higher peak systolic velocity and end diastolic velocity have been documented in neonates with EONS. CONCLUSION: Our study shows that the cerebral hemodynamics in neonates with EONS is altered which can be assessed bedside by noninvasive ultrasound Doppler examination.

An unusual case of retained abdominal pregnancy for 36 years in a postmenopausal woman.

Abdominal pregnancy is a rare form of ectopic pregnancy which occurs due to ruptured uterine or tubal pregnancy into the abdomen. Fetal loss is a common complication of these pregnancies and patient presents with acute abdominal pain which is a surgical emergency. Another rare but established complication of this ectopic pregnancy is fetal demise with the dead fetus being retained in the abdomen. It gets macerated and mummified over a period of time and is mostly detected incidentally during imaging. Radiological imaging has hallmark appearances of such a macerated fetus showing multiple fetal parts embedded in a calcified sac termed as lithopedion or stone baby. We report a unique case of retained abdominal pregnancy for 36 years in a 60-year-old postmenopausal female presented with abdominal pain and difficulty in micturition. Computed tomography showed multiple fetal bones in the abdomen surrounded by a membrane which was surprisingly not calcified.

High-frequency ultrasound in parotid gland disease.

Parotid gland is involved in many inflammatory and neoplastic conditions. Many a times, it is difficult to ascertain the type of swelling by clinical examination. The anatomy and various abnormalities of the glands are very easily visualized by high-frequency ultrasound. Ultrasound can confirm the presence of the mass with sensitivity up to 100%. It can demonstrate whether a lesion is located in the parotid gland or outside. It can help in differentiating benign from malignant neoplasms and local staging of the mass in malignant lesions. In addition, ultrasound can identify those entities that may not need surgical intervention. The glands appear enlarged and show altered echopattern in acute inflammation and may be normal or reduce in size in chronic inflammation. Other pathologies that involve salivary glands are sialolithiasis and various benign and malignant neoplasms. Ultrasound many times suggests final diagnosis or supplies important differential diagnosis. In this article, the use of high-frequency ultrasound in parotid disease is discussed, and sonographic features of different parotid pathologies are reviewed with examples illustrated. High-frequency ultrasound is the first and many a times the only imaging investigation done for evaluation of parotid glands.