A Fatal Case of a Huge Brain Abscess Misdiagnosed as Migraine Headache in an 18-Year-Old Woman.

BACKGROUND: Mortality associated with delayed diagnosis of brain abscess is high. A high index of suspicion in conjunction with the use of neuroimaging is important for the early diagnosis of brain abscess. Early use of appropriate antimicrobial and neurosurgical care improves outcomes. METHODS: We report a fatal case of an 18 year old female with a huge brain abscess who was misdiagnosed as a case of migraine headache over a 4-month period in a referral hospital. REPORT: An 18-year-old female with a missed history of recent furuncles occurring in the right frontal part of her head and right upper eyelid who presented with a recurrent throbbing headache to a private hospital over 4 months. There was a positive maternal history of episodic headaches, as such, the patient was diagnosed as having a migraine headache disorder at the private hospital. The patient was referred to our facility on account of repeated seizures over 2 days and lapsing into a coma. Clinical examination showed evidence of focal neurologic deficits and a suspicion of brain abscess was confirmed with an urgent cranial MRI. She succumbed to her illness within 3hrs of presentation. CONCLUSION: Detailed history, a high index of suspicion, use of appropriate neuroimaging and early diagnosis is important in reducing the mortality associated with brain abscess.

CONTEXTE: La mortalité associée à un diagnostic tardif d'abcès cérébral est élevée. Un indice de suspicion élevé associé à l'utilisation de la neuro-imagerie est important pour le diagnostic précoce de l'abcès cérébral. L'utilisation précoce d'antimicrobiens et de soins neurochirurgicaux appropriés améliore les résultats. MÉTHODES: Nous rapportons le cas mortel d'une jeune femme de 18 ans atteinte d'un énorme abcès cérébral qui a été diagnostiqué à tort comme un cas de migraine sur une période de 4 mois dans un hôpital de référence. RAPPORTS: Une jeune femme de 18 ans, sans antécédents de furoncles récents survenus dans la partie frontale droite de la tête et sur la paupière supérieure droite, s'est présentée dans un hôpital privé avec des céphalées lancinantes récurrentes sur une période de 4 mois. Les antécédents maternels de maux de tête épisodiques étant positifs, la patiente a été diagnostiquée comme souffrant de migraines à l'hôpital privé. La patiente a été adressée à notre établissement en raison de crises épileptiques répétées pendant deux jours et d'une chute dans le coma. L'examen clinique a révélé des déficits neurologiques focaux et une suspicion d'abcès cérébral a été confirmée par une IRM crânienne urgente. Elle a succombé à sa maladie dans les 3 heures qui ont suivi sa présentation. CONCLUSION: Une anamnèse détaillée, un indice de suspicion élevé, l'utilisation d'une neuro-imagerie appropriée et un diagnostic précoce sont importants pour réduire la mortalité associée aux abcès cérébraux. Mots clés: Abcès cérébral, Céphalée primaire, Céphalée secondaire, Migraine.

Spleen-left kidney ratio and liver-right kidney ratio: novel measures of normal liver, spleen, and kidney dimensions in Southwestern Nigerian children.

PURPOSE: Figures can sometimes be difficult to handle when considering whether the ultrasound dimensions of the liver, spleen, and kidneys of children are within normal limits in a typical clinical setting. Therefore, it is imperative to think of a simple measure that can be easily adopted when the question of whether these organs are enlarged or reduced in size is to be answered by a sonologist. We hypothesize that the liver-right kidney ratio and spleen-left kidney ratio are constant, regardless of age and sex among children, provided that the reference organ is not diseased. METHODS: This observational, cross-sectional study was carried out in public primary schools in the Ogbomoso metropolis. A total of 1000 apparently healthy children aged 5-13 were subjected to abdominal sonography from July 2016 to December 2016. The length of the liver, spleen, and both kidneys as well as the anthropometric parameters of each subject were obtained and correlated. Data were analyzed using SPSS version 20. RESULTS: The SPL:LKL (spleen to left kidney length) ratio varies with age, and this is statistically significant in female subjects (p = 0.042), but not in males (p = 0.360). The RLL:RKL (right lobe of the liver to right kidney length) ratio of 1.19 ± 0.18 does not significantly vary with age or sex (p = 0.337). CONCLUSION: The SPL:LKL ratio of 1.11 ± 0.18 can be only used as a measure of normality of organ dimensions in males. On the contrary, the RLL:RKL of 1.19 ± 0.18 can be used in all children, regardless of sex, provided that the reference organ is normal.

Maternal serum CA 19-9 and CA 15-3 levels in pregnancies affected by trisomy 21.

OBJECTIVES: To investigate the levels of tumour markers CA 19-9 and CA 15-3 in the first trimester maternal serum of euploid control and trisomy 21 pregnancies. METHODS: Maternal serum marker levels of 69 trisomy 21 and 388 euploid controls were quantified by the Kryptor analyser, and levels were compared between the two groups after analysis for confounding factors. Monte Carlo simulation was carried out to determine the effect of adding potential markers to the combined test. RESULTS: Neither marker was affected by gestational age; however, CA 19-9 required correction for maternal weight. CA 19-9 was significantly increased in trisomy 21 pregnancies (0.98 MoM in euploid, 1.16 MoM in trisomy 21, p = 0.024). Levels of CA 15-3 were not found to differ significantly (1.03 MoM in euploid, 1.09 in trisomy 21, p = 0.130). Detection rates were unaffected by addition of CA 19-9 to the combined test. CONCLUSION: Although a small significant increase in CA 19-9 levels was found in trisomy 21 group, it is unlikely to be of any use as part of a trisomy 21 screening tool.