Stem Cell Transplantation for Multiple Sclerosis: A 2023 Review of Published Studies.

This comprehensive literature review underscores the potential of stem cell transplantation (SCT) as a therapeutic intervention for multiple sclerosis (MS). By amalgamating evidence from various sources, including randomized controlled trials (RCTs), observational, retrospective, and comparative studies, this review offers a holistic understanding of SCT's effectiveness, safety, and feasibility in diverse contexts of MS management. SCT has shown promise in mitigating disease activity and progression, particularly in relapsing-remitting MS (RRMS). RCTs like the high dose immunoablation and autologous hematopoietic stem cell transplantation in MS (ASTIMS) versus mitoxantrone therapy in severe multiple sclerosis and multiple sclerosis international stem cell transplant (MIST) trials reveal SCT's capacity to reduce new lesion occurrences and inflammatory activity. However, variability exists in disability score improvements among these studies. Observational and retrospective investigations further affirm SCT's potential, highlighting decreased relapse rates, enhanced expanded disability status scale (EDSS) scores, and a noteworthy proportion of patients achieving no evidence of disease activity (NEDA). The initial literature search using all of the search items produced a total of 3,636 articles. After title, abstract, and article type screening and article retrieving, 147 articles were assessed for eligibility using the inclusion criteria. At the end of the literature search, 37 articles met the eligibility criteria. They were included in our review according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Patients treated with hematopoietic stem cell transplantation (HSCT) present lower progression and relapse rates, suppression of inflammatory activity, and a greater reduction in T2 lesions on MRI than those treated with disease-modifying therapies (DMTs). In summary, while SCT presents promise as a therapeutic option for MS, its deployment should be tailored to individual patient characteristics, disease stages, and responses.

A Rare Intrathecal Pump Complication Caused by Prolonged Seroma Leading to a Potential Pump Pocket Fill: A Near Miss.

Intrathecal drug delivery systems have been used with increasing frequency in patients with chronic intractable pain. Common complications of intrathecal drug delivery systems include surgical bleeding, spinal cord injury, fractured or migrated catheter, meningitis, pump failure, granuloma formation, cerebral spinal fluid leak, and hygroma formation. We present a rare near-miss case that could have led to the inadvertent filling of an intrathecal pump pocket with a high concentration of narcotic and local anesthetic. This situation arose due to the discovery of a prolonged intrathecal pump pocket seroma during a routine maintenance and refill procedure.

A Case Report of Sphenopalatine Ganglion Block Relieving Chronic Pain Post-Dental Bone Graft Surgery.

Chronic orofacial pain, by definition, is a pain that can anatomically extend anywhere between the area just under the orbitomeatal line, anterior to the pinnae, and above the neck. It occurs for 15 days or more per month, lasting four or more hours daily, for at least three months. Chronic orofacial pain, including persistent idiopathic facial pain syndrome, can significantly impact patients' quality of life and pose challenges for effective management. This case report describes a successful transnasal approach in treating a patient with severe oral pain following a bone graft surgery by blocking the sphenopalatine ganglion. The block provided significant pain relief and improved the patient's daily functioning. This minimally invasive treatment option offers an alternative for managing chronic orofacial pain after dental procedures such as bone graft surgery.

Revolutionizing Treatment for Chronic Subdural Hematoma: Promising Outcomes With Middle Meningeal Artery Embolization.

Chronic subdural hematoma (cSDH) is a common condition that typically requires surgical intervention. Middle meningeal artery embolization (MMAE) has emerged as a potential alternative treatment option, although the choice of embolization material remains a topic of debate. In this case series, we report on the outcomes of 10 patients with cSDH who underwent MMAE. Most patients experienced symptom relief and a significant reduction in cSDH size post-procedure. Despite the presence of comorbidities and risk factors, most patients had positive outcomes following MMAE treatment. Only one patient required surgical intervention after the MMAE procedure due to the progression of symptoms, while MMAE successfully prevented recurrence in most patients. Our findings suggest that MMAE can be a promising treatment option for selected patients with cSDH. However, further studies are needed to compare the efficacy and safety of different embolization materials in MMAE procedures for cSDHs.

Echocardiogram-Guided Diagnosis of Anomalous Coronary Arteries: A Rare Presentation.

Incidentaloma, a term that embodies the detection of certain problems during the performance of unreasonable investigations, resonates in the medical field. Retroaortic coronary sign is a recently recognized echocardiographic feature of the anomalous coronary artery. It is typically associated with anomalies of the left coronary artery, especially the left circumflex artery. As far as has been monitored, few echocardiographic signs that correlate with this feature have been identified. This feature often remains underdiagnosed on transthoracic echocardiograms due to confusion with artifacts, calcifications, and other cardiac structures. A 45-year-old male patient underwent regular cardiac routine assessment. Retroaortic anomalous coronary (RAC) sign was incidentally detected by transthoracic thoracic echocardiogram; consequently, the retroaortic route of the coronary artery was suspected. Coronary computed tomography angiography was requested to confirm the seen echocardiographic signs. After a 3D reconstruction imaging, the left circumflex retroaortic course was identified with right coronary sinus origin. This case ensures the importance of transthoracic echocardiography as a noninvasive tool in diagnosing anomalous coronary arteries. These anomalies are usually diagnosed by coronary computed tomography angiography and coronary angiography, mainly in the presence of retroaortic coronary sign or "crossed aorta sign."

Spinal Dural Arteriovenous Fistula: Insights Into Operative Management.

Spinal Dural Arteriovenous Fistula (SDAVF) is a rare and complex vascular condition with significant neurological consequences if left untreated. We present a case of SDAVF in a 46-year-old male who presented with progressive myelopathy. The patient presented with a three-month history of progressive lower extremity weakness, numbness, urinary retention, constipation, and gait disturbance. The spine's magnetic resonance imaging (MRI) showed diffuse T2 hyperintensity and contrast enhancement from T11 to L1, raising the suspicion of an intradural spinal cord lesion. Further evaluation with spinal angiography revealed an SDAVF at the level of T11-T12. The patient underwent surgical resection of the fistula, His lower extremity weakness and numbness improved significantly after surgery, and he was discharged with a plan for close follow-up. Early diagnosis and appropriate treatment prevent neurological deficits and improve patient outcomes. Surgical resection of the fistula can significantly improve neurological symptoms and should be considered a treatment option for SDAVF.