RESUMO
Chronic mesenteric ischemia (CMI) is uncommon and accounts for approximately 5% of cases. CMI presents with non-specific symptoms, making it difficult to diagnose, and requires complex management involving interprofessional teams. We present the case of a 66-year-old female who presented with postprandial abdominal pain, vomiting, sitophobia, and weight loss. Investigations showed raised inflammatory markers, and plain film X-ray and endoscopy showed no significant findings. CT angiogram showed celiac and mesenteric artery thrombosis. The patient proceeded to have endovascular revascularization. With this case, we highlight the importance of considering CMI in an elderly patient with a history of microvascular disease or risk factors presenting with postprandial abdominal pain and weight loss. Early diagnosis and timely intervention are imperative for a good prognosis.
RESUMO
Spontaneous intracranial hypotension is a rare disease that results from low cerebrospinal fluid (CSF) volume caused by leakage of CSF from the spine in the absence of lumbar puncture, spine surgery, or intervention. The most common presentation is the headache that is usually but not invariably orthostatic. The underlying pathology is a CSF leak resulting from dural weakness involving the nerve root sleeves, ventral dural tears associated with calcified disc herniations, or CSF venous fistula. In severe cases, neuropsychiatric symptoms and changes in mental status may develop. Some case reports also mention gait disturbances, slurred speech, and urinary incontinence. The constellation of neuropsychiatric symptoms similar to behavior variant frontotemporal dementia in the presence of "brain sag" on MRI is known as frontotemporal brain sagging syndrome, first described by Wicklund et al. (4). The disease presents a diagnostic challenge to the primary care physicians, who are the first to see these patients. Brain and spine imaging is key to diagnoses but requires a high index of suspicion, as very rarely are all classic findings of intracranial hypotension present in the same patient. Here we discuss a case of spontaneous intracranial hypotension in a 45-year-old male patient who presented with headache, drowsiness, incoherent speech, behavior symptoms, and altered mental status.
RESUMO
Chondroblastoma is an uncommon osseous neoplasm that accounts for less than 1% of all bone tumors. Characteristically it arises in the epiphysis or apophysis of long bones in young patients and may extend into the metaphysis. A sixteen-year-old male presents with a 1-year history of left knee pain associated with joint stiffness and interfering with performing daily activities. Radiographic and contrast enhanced magnetic resonance imaging favored the diagnosis of chondroblastoma. This was then confirmed histologically. The clinical signs and symptoms of Chondroblastoma are usually nonspecific, pain is most often moderate and can be revealed as a result of a trauma. The definitive diagnosis is mainly pathological due to the lack of specificity of radiological findings consistent with the presented case.
