Clinical Case Reports最新文献_第2页

Extensive Parenchymal Brain Calcification in a Patient With Autosomal Dominant Polycystic Kidney Disease and Stage 5 Chronic Kidney Disease. 常染色体显性多囊肾病和5期慢性肾病患者的广泛脑实质钙化

IF 0.6

Clinical Case Reports Pub Date : 2026-10-15 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73595

Noorelle Khan, Nicholas Streicher

{"title":"Extensive Parenchymal Brain Calcification in a Patient With Autosomal Dominant Polycystic Kidney Disease and Stage 5 Chronic Kidney Disease.","authors":"Noorelle Khan, Nicholas Streicher","doi":"10.1002/ccr3.73595","DOIUrl":"10.1002/ccr3.73595","url":null,"abstract":"Extensive parenchymal brain calcification is uncommon in chronic kidney disease (CKD): intracranial vascular calcification affects up to 10% of uremic patients, but widespread Fahr-type parenchymal deposits are rare and, where reported, have occurred in patients with a coexisting hypoparathyroid or parathyroid-hormone (PTH)-resistant state. We describe a man in his 50s with autosomal dominant polycystic kidney disease (ADPKD) and Stage 5 CKD who presented with word-finding difficulty, gait imbalance, and myoclonus and was found to have extensive symmetric calcification of the basal ganglia, thalami, dentate nuclei, and subcortical white matter. He carried an unverified childhood diagnosis of pseudohypoparathyroidism made at age 13. At presentation, total calcium was 6.1-6.3 mg/dL, phosphate 5.8 mg/dL, intact PTH 194 pg/mL, creatinine 6.21 mg/dL, and alkaline phosphatase normal. Over the following 10 months, intact PTH fell rather than rose, reaching 56 pg/mL during treatment with calcium, calcitriol, sevelamer, and hemodialysis, all of which lower PTH whatever the underlying cause. The calcium-phosphate product was low at presentation (36.5 mg2/dL2) but rose to 58-62 mg2/dL2 later, and single values cannot exclude earlier CKD-related mineral abnormality. No pathogenic variant was identified on an 866-gene panel. Neither the product nor the PTH trajectory separated renal from non-renal contributions. We present this as a diagnostic-reasoning case that raises, but cannot resolve, the question of causation and suggest that such calcification should not be attributed to CKD-mineral and bone disorder by default.","PeriodicalId":10327,"journal":{"name":"Clinical Case Reports","volume":"14 10","pages":"e73595"},"PeriodicalIF":0.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Multidisciplinary Management of a Giant Ovarian Sertoli-Leydig Cell Tumor Presenting With Isosexual Precocious Puberty: A Pediatric Case Report. 一例以同性性早熟为表现的巨大卵巢支持-间质细胞肿瘤的多学科治疗：一个儿科病例报告。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-15 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73700

Sanaa Bouramdane, Kenza Elmkaddem, Nawal Hammas, Meryem Boubbou, Othmane Alaoui, Khalid Khattala, Youssef Bouabdellah, Sarra Benmiloud

{"title":"Multidisciplinary Management of a Giant Ovarian Sertoli-Leydig Cell Tumor Presenting With Isosexual Precocious Puberty: A Pediatric Case Report.","authors":"Sanaa Bouramdane, Kenza Elmkaddem, Nawal Hammas, Meryem Boubbou, Othmane Alaoui, Khalid Khattala, Youssef Bouabdellah, Sarra Benmiloud","doi":"10.1002/ccr3.73700","DOIUrl":"10.1002/ccr3.73700","url":null,"abstract":"Sertoli-Leydig cell tumors (SLCTs) are rare ovarian sex cord-stromal tumors, particularly uncommon in the pediatric population. They are typically androgen-secreting, while estrogen-secreting forms are rare and may lead to diagnostic confusion with granulosa cell tumors. We report the case of a 7-year-old girl presenting with progressive abdominal distension and isosexual precocious puberty. Imaging revealed a large abdominopelvic mass of uncertain origin. Histopathological examination of a biopsy suggested a sex cord-stromal tumor. The patient received neoadjuvant chemotherapy with the VIP regimen, resulting in significant tumor reduction, followed by fertility-sparing surgery. Final histopathological and immunohistochemical analysis confirmed a SLCT. The tumor was classified as FIGO stage IC2 due to preoperative capsular breach. Postoperatively, an additional cycle of chemotherapy was administered. Hormonal markers, including estradiol and inhibin B, normalized after treatment. During follow-up, a transient rise in these markers was observed in the absence of radiological abnormalities, followed by spontaneous normalization. The patient remains in complete remission after 27 months of follow-up. This case highlights an atypical estrogen-secreting pediatric SLCT and underscores the importance of histopathological confirmation in unusual clinical presentations. It also illustrates the potential role of neoadjuvant chemotherapy in large tumors and supports the use of inhibin B as a biomarker for disease monitoring, although its interpretation should be cautious and integrated with clinical and imaging findings. Long-term follow-up is essential due to the risk of recurrence.","PeriodicalId":10327,"journal":{"name":"Clinical Case Reports","volume":"14 10","pages":"e73700"},"PeriodicalIF":0.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671097/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Recurrent Large-Vessel Occlusive Stroke Requiring Repeated Mechanical Thrombectomy in Severe Dilated Cardiomyopathy With Extremely Low Left Ventricular Ejection Fraction and HIV Screening Positivity: A Case Report. 严重扩张型心肌病左室射血分数极低且HIV筛查阳性的复发性大血管闭塞性卒中需要反复机械取栓1例报告。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-15 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73734

Jing Xu, Liangxu Xiang, Yanghua Tian

引用次数: 0

Reflex-Mediated Bradycardia and Asystole During Skull Base and Parapharyngeal Surgery: A Three-Case Series Highlighting Anatomical Predictability. 颅底和咽旁手术中反射介导的心动过缓和心脏骤停：一个突出解剖可预测性的三例系列。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-15 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73752

Songyuan Chi, Yiru Wang, Xia Shen

{"title":"Reflex-Mediated Bradycardia and Asystole During Skull Base and Parapharyngeal Surgery: A Three-Case Series Highlighting Anatomical Predictability.","authors":"Songyuan Chi, Yiru Wang, Xia Shen","doi":"10.1002/ccr3.73752","DOIUrl":"10.1002/ccr3.73752","url":null,"abstract":"Intraoperative bradycardia and asystole during cranial neurovascular surgery are often regarded as unexpected events. In clinical practice, however, these episodes may occur during manipulation of specific cranial nerve-rich anatomical regions, suggesting that the risk may be anticipated and clinically actionable. We report three patients who developed suspected reflex-mediated cardioinhibitory events during surgery involving the jugular foramen, pericarotid skull base, and parapharyngeal space. The events occurred during operations involving regions in which glossopharyngeal or vagal pathways may be vulnerable, although the exact triggering structure could not be confirmed in all cases. Severity ranged from transient bradycardia to prolonged asystole requiring resuscitation. We summarize the cases in a comparative table and propose a practical management pathway emphasizing preoperative recognition of high-risk anatomical regions, immediate interruption of surgical stimulation, graded pharmacologic treatment, and selective temporary pacing. These cases highlight that reflex-mediated cardioinhibition in selected skull base and parapharyngeal operations may be anticipated through anatomy-based perioperative reasoning.","PeriodicalId":10327,"journal":{"name":"Clinical Case Reports","volume":"14 10","pages":"e73752"},"PeriodicalIF":0.6,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Disseminated Mixed Lytic-Sclerotic Skeletal Metastases as Initial Presentation of Gallbladder Carcinoma: A Case Report. 胆囊癌首发表现为弥散性溶性-硬化性骨转移1例。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-15 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73745

Shivali Rao, Binaya Adhikari, Abhikanta Khatiwada

引用次数: 0

Severe Intraoperative Airway Leak Revealing Undiagnosed Mounier-Kuhn Syndrome in an Elderly Patient. 老年患者术中严重气道漏出未确诊的穆尼尔-库恩综合征1例。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-14 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73738

Xuyang Chen, Shuai Miao, Difei Zhou, Xin Zhang

引用次数: 0

The Hemodynamic Trap: Fetal-Type Posterior Cerebral Artery and Occult PICA Aneurysms. 血流动力学陷阱：胎儿型大脑后动脉和隐性异食动脉瘤。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-14 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73711

Seyedeh Hamideh Khadem, Asal Ghari Saadati, Amirhossein Fathabadi, Farzaneh Khoroushi

{"title":"The Hemodynamic Trap: Fetal-Type Posterior Cerebral Artery and Occult PICA Aneurysms.","authors":"Seyedeh Hamideh Khadem, Asal Ghari Saadati, Amirhossein Fathabadi, Farzaneh Khoroushi","doi":"10.1002/ccr3.73711","DOIUrl":"10.1002/ccr3.73711","url":null,"abstract":"Isolated intraventricular hemorrhage (IVH) is an uncommon presentation of ruptured aneurysms, often misdiagnosed as hypertensive hemorrhage. Distal posterior inferior cerebellar artery (PICA) aneurysms can easily be missed on computed tomography angiography (CTA) due to their small size and skull-base artifacts. A 48-year-old female presented with a thunderclap headache. Initial imaging showed isolated IVH without subarachnoid hemorrhage. A primary CTA was read as negative, noting only a suspected plaque near the foramen magnum. However, multiformat reconstructions revealed a right-sided fetal-type posterior cerebral artery (fPCA) and a dominant left vertebral artery. High clinical suspicion prompted digital subtraction angiography (DSA), which confirmed a 3 × 3 mm distal PICA aneurysm exactly where the \"plaque\" was suspected on the CTA. This case highlights the limitations of CTA in the posterior fossa. It also suggests a hemodynamic mechanism for aneurysm formation: the combination of an fPCA and asymmetric vertebral inflow alters local blood flow. We hypothesize that this architectural mismatch may cause turbulence and increased wall shear stress, predisposing the distal PICA to aneurysm formation. In patients with isolated IVH and an fPCA variant, a negative CTA cannot definitively rule out a vascular lesion. Early DSA is essential to detect occult aneurysms and prevent subsequent rebleeding.","PeriodicalId":10327,"journal":{"name":"Clinical Case Reports","volume":"14 10","pages":"e73711"},"PeriodicalIF":0.6,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13669664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Abdominal Pain as the First Presentation of Severe Heart Failure With Reduced Ejection Fraction and Left Ventricular Thrombus in a Young Asymptomatic Patient: A Diagnostic Interception. 腹痛是年轻无症状患者伴射血分数降低和左心室血栓的严重心力衰竭的第一表现：一种诊断拦截。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-14 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73699

Maryam Othman Alarfaj, Bashayr Saleh Alsuwailem, Meataz Khaled Aljeezan, Baker Saud Alhlibi, Mubarak Maher Bu Haya, Abdulatif Adel Alnaaim, Muneera O AlTaweel

引用次数: 0

A Preschooler With Severe Social Anxiety and Selective Mutism Versus Autism Spectrum Disorder. 有严重社交焦虑和选择性缄默症的学龄前儿童与自闭症谱系障碍。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-14 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73706

Anna Dowling, Erin Moxey, Meghan Keenan, Ji Su Hong

引用次数: 0

Contiguous Lumbar Bilateral Pars Defects at L3 and L4 (With Intact L5): Treated With Pedicle Screw Fixation and Interbody Fusion: A Case Report With Literature Review. 椎弓根螺钉固定和椎间融合治疗L3和L4腰椎双侧部连续缺损（L5完整）1例报告并文献复习。

IF 0.6

Clinical Case Reports Pub Date : 2026-10-14 eCollection Date: 2026-10-01 DOI: 10.1002/ccr3.73556

Muhammad Rizwan Ali, Muhammad Jawad Saleem, Ali Shahid, Muhammad Suliman Sajid, Muhammad Haris, Shayan Asmat, Noor Ul Subah Afzal, Mohammad Al Diab Al Azzawi

引用次数: 0