Annals of Medicine & Surgery最新文献

{"title":"Compartment syndrome of arm secondary to snake bite on hand: a case report","authors":"A. Dahal, A. Basi, R. Shrestha, S. K. Khadka, Arjun Das, M. Malla, Arshima Dahal, A. Chaudhary","doi":"10.1097/ms9.0000000000002253","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002253","url":null,"abstract":"\u0000 \u0000 Snake bites pose a significant common public health concern, with more prevalence in rural areas. Compartment syndrome (CS) is one of the rare and severe manifestations of snake bite wherein venom-induced swelling within a closed anatomical compartment leads to increased pressure which may result in ischemic damage to nerves and muscle. Anti-snake venom and prompt fasciotomy is recommended for management of CS secondary to snake bite.\u0000 \u0000 \u0000 \u0000 Here we report a case of 47 years female with Green Pit Viper bite on the left hand. Upon arrival to hospital, initial resuscitation measures were initiated. Six hours following the bite, there was severe pain on passive stretch and paresthesia. Ten vials of Anti-snake venom (ASV) administration along with fasciotomy of hand and arm resulted in notable alleviation of pain and swelling. Eighteen pint of blood was transfused for coagulopathy and low hemoglobin. After continued care of wound and intensive physiotherapy, functional limb could be achieved.\u0000 \u0000 \u0000 \u0000 Snakebite envenomation is one of the biggest hidden health crises with case fatality rate of 7.8% in the southern plains of Nepal. As in our case, snake bites commonly affect upper extremities, accounting for around two third of all cases. Compartment syndrome must be differentiated from acute swelling, which sometimes may be difficult. Surgical decompression is indicated in presence of signs and symptoms of compartment syndrome, in case of resource limited setting.\u0000 \u0000 \u0000 \u0000 Multidisciplinary and prompt management with initial resuscitation, ASV administration, fasciotomy, and rehabilitative measures can save both life and limb in such cases.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"1 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geriatric oral health neglect: calculus on the attached gingiva; A case report","authors":"Okereke Promise Udohchukwu, Chimeremeze Offurum, Victor Anezi Eze, Okpechukwu Chidubem Peter, Ifedibar Wisdom Chisom, Ezi Akaji Abigail","doi":"10.1097/ms9.0000000000002230","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002230","url":null,"abstract":"\u0000 \u0000 Aging exerts various effects on and causes changes to the oral tissues. It is often difficult to distinguish between what is caused by the physiological process of aging itself and what is caused by the individual’s lifestyle or diseases. The elderly face peculiar health challenges and require special dental care. It is therefore vital that greater attention be given to the oral health needs of this rapidly population. In this article, we present the case of an elderly female patient with a rare case of calculus on the attached gingiva.\u0000 \u0000 \u0000 \u0000 A 90-year-old retired teacher with a history of hypertension, presented with a small, painless, grayish-brown growth on her attached gingiva, noticed by her daughter-in-law. Examination revealed signs of gingivitis and significant dental issues including missing teeth, fractures, and calculus buildup. Diagnosis of Chronic Generalized Marginal Gingivitis and calculus deposition was made, and scaling and polishing were performed. Perforation of the attached gingiva was observed during scaling thus exposing the root, which facilitated the calculus accumulation. Post-procedure care included medication and oral hygiene instructions. Follow-up after one week showed satisfactory healing, but subsequent assessment at three months revealed plaque accumulation, with the patient declining further treatment.\u0000 \u0000 \u0000 \u0000 The patient shows a relative neglect in oral healthcare given the subpar oral health features she exhibited and decline of further treatment options presented to her. This is common in the population as some abnormal oral presentations and features are perceived as normal in the population which can be attributed to poor knowledge of oral health practices which affects the illness seeking behaviour of individual.\u0000 \u0000 \u0000 \u0000 Calculus deposition in the oral cavity requires a hard surface for formation, and proper oral hygiene practices are essential to mitigate its adverse effects, particularly among the elderly who may require additional attention due to their unique physiological changes.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"13 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267505","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilomatricoma of the calf: A case report and review of literature","authors":"S. Bourabaa, O. Bourouail, Othman Arsalan, Zakaria Elbarkaoui, N. Rguieg, Amine Souadka","doi":"10.1097/ms9.0000000000001905","DOIUrl":"https://doi.org/10.1097/ms9.0000000000001905","url":null,"abstract":"\u0000 \u0000 Pilomatricoma (PMC) is a benign adnexal dermal or subcutaneous tumor which is derived from immature hair matrix cells. It makes up around 20% of all tumors related to hair follicles in most series and is therefore the most common hair-follicle neoplasm. Nevertheless, diagnosing it remains intricate due to the prevalence of more frequent pathological conditions in soft-tissue. Anatomopathological examination proves to be a valuable asset, offering a definitive and certain diagnosis.\u0000 \u0000 \u0000 \u0000 We hereby present a case of a 17-year-old patient with no medical history, who was referred to our medical unit subsequent to the emergence of swelling in the right calf. MRI results highlighted the presence of a subcutaneous nodule situated on the right calf. Following a percutaneous biopsy, the diagnosis of PMC was definitively confirmed. A successful surgical excision of the tumor was performed, and the postoperative progress demonstrated positive outcomes.\u0000 \u0000 \u0000 \u0000 PMC usually appears as flesh-colored to white, firm papules or papulonodules that may have an overlying pink to blue hue. MRI plays a crucial role in diagnosis, as it delineates the tumor’s extent in relation to the skin and muscle compartments. Preoperative histological confirmation is essential to rule out other potential diagnoses and precisely establish the required resection margins.\u0000 \u0000 \u0000 \u0000 PMC is an infrequent occurrence in general surgery departments. General surgeons should, however, be well-acquainted with this benign tumor while assessing soft tissue masses.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"67 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally invasive approaches versus conventional sternotomy for aortic valve replacement in patients with aortic valve disease: a systematic review and meta-analysis of 17,269 patients","authors":"Saad Khalid, Muhammad Hassan, Abraish Ali, Farah Anwar, M. Siddiqui, Sunita Shrestha","doi":"10.1097/ms9.0000000000002204","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002204","url":null,"abstract":"\u0000 \u0000 Aortic valve replacement (AVR) is a common procedure for aortic valve pathologies, particularly in the elderly. While traditional open AVR is established, minimally invasive techniques aim to reduce morbidity and enhance treatment outcomes. Our meta-analysis compares these approaches with conventional sternotomy, offering insights into short and long-term mortality and postoperative results. This study provides valuable evidence for informed decision-making between conventional and minimally invasive approaches for AVR.\u0000 \u0000 \u0000 \u0000 Till august 2023, PubMed, Embase, and MEDLINE databases were searched for Randomized controlled trials (RCT) and propensity score matched (PSM) studies comparing minimally invasive approaches [mini-sternotomy (MS) and right mini thoracotomy (RMT)] with full sternotomy (FS) for AVR. Various outcomes were analyzed, including mortality rates, bypass and clamp times, length of hospital stay, and complications. Risk ratios (RR) and the weighted mean differences (WMD) with corresponding 95% confidence intervals were calculated using Review Manager.\u0000 \u0000 \u0000 \u0000 Forty-eight studies were included having 17,269 patients in total. When compared to FS, there was no statistically significant difference in in-hospital mortality in MS (RR:0.80; 95%CI:0.50 to 1.27; I2=1%; P=0.42) and RMT (RR:0.70; 95%CI:0.36 to 1.35; I2=0%; P=0.29). FS was also linked with considerably longer cardiopulmonary bypass duration than MS (MD:8.68; 95%CI:5.81 to 11.56; I2=92%; P=0.00001). The hospital length of stay was determined to be shorter in MS (MD:−0.58; 95%CI:−1.08 to −0.09; I2=89%; P=0.02) with no statistically significant difference in RMT (MD:−0.67; 95%CI:−1.42 to 0.08; I2=84%; P=0.08) when compared to FS.\u0000 \u0000 \u0000 \u0000 While mortality rates were comparable in minimally invasive approaches and FS, analysis shows that MS, due to fewer respiratory and renal insufficiencies, as well as shorter hospital and ICU stay, may be a safer approach than both RMT and FS.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deficiency of Adenosine Deaminase 2 (DADA2) with bilateral renal subcapsular hematoma: A case report and literature review","authors":"Anas R. Tuqan, Anas M. Barabrah, Basel A. Zaben, M. H. Shehadeh, Motaz M. Adas","doi":"10.1097/ms9.0000000000001812","DOIUrl":"https://doi.org/10.1097/ms9.0000000000001812","url":null,"abstract":"\u0000 \u0000 Deficiency of adenosine deaminase 2 (DADA2) is a rare autosomal recessive genetic disorder caused by loss-of-function mutations in the adenosine deaminase 2 gene. This condition primarily manifests in pediatric cases before the age of 10 years, with sporadic cases reported in adults. Adenosine deaminase 2 (ADA2) is a critical enzyme involved in macrophage differentiation and immune homeostasis. The clinical manifestations of DADA2 vary widely and can affect multiple organ systems. Our case uniquely highlights an infrequent DADA2 manifestation.\u0000 \u0000 \u0000 \u0000 An 18-year-old female presented with right flank pain, fever, and a history of joint pain, Raynaud’s phenomenon, livedo-like rash, and chronic abdominal pain. Physical examination revealed subcapsular hematoma in the right kidney. Further evaluation showed positive serologic tests for rheumatoid factor and anti-nuclear antibody (ANA). Genetic testing confirmed DADA2 homozygosity. The patient was discharged on the appropriate medications.\u0000 \u0000 \u0000 \u0000 DADA2 is associated with vascular dysfunction and systemic vasculopathy. The clinical manifestations of DADA2 encompass a spectrum of organ involvement, including the skin, nervous system, gastrointestinal system, renal system, and the cardiovascular system. Early recognition and diagnosis are crucial for appropriate management.\u0000 \u0000 \u0000 \u0000 This case report highlights the diverse clinical presentations of ADA2 deficiency, specifically focusing on bilateral renal subcapsular hematoma. This finding emphasizes the importance of considering DADA2 as a differential diagnosis in patients presenting with unexplained renal manifestations. Increased awareness of the varied clinical presentations of DADA2 will contribute to earlier diagnosis, appropriate management, and improved outcomes in patients affected by this rare genetic disorder.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"7 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transabdominal fetal reduction in higher order multiple pregnancies – A pioneer cohort retrospective study in Nepal","authors":"Sharma Paudel, Prajwal Dahal, P. Pant, Nilam Subedi","doi":"10.1097/ms9.0000000000002252","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002252","url":null,"abstract":"\u0000 \u0000 To share initial experience of transabdominal multifetal pregnancy reduction (MFPR) in Nepal.\u0000 \u0000 \u0000 \u0000 The procedure was performed in 108 patients in a private hospital over a period of 3 years. Under ultrasound guidance, intracardiac injection of 0.2 to 3.0 ml of 15% w/v (2 mEq/mL) potassium chloride (KCl) was administered via transabdominal route.\u0000 \u0000 \u0000 \u0000 A total of 108 fetal reduction procedures were carried out at the seventh to fifteenth weeks of gestation, a maximum of 44 (40.7%) of which were done at the ninth to tenth weeks of gestation. A total of 123 fetuses were reduced. Out of total 108 multifetal pregnancies, 96 (88.8%) were due to In Vitro fertilization (IVF). 85 pregnancies (78.7%) underwent reduction from triplet to twin. The second-time reduction was needed in 5 cases. Two attempts (in the same sitting) were required in 3 cases. Inadvertent demise of the second fetus was noted in 3 cases of dichorionic triamniotic triplet pregnancy.\u0000 \u0000 \u0000 \u0000 Ultrasound-guided transabdominal fetal reduction performed between the seventh and twelfth weeks of gestation is safe and effective.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"5 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141267456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous endocardial septal radiofrequency ablation on syncope in patients with hypertrophic obstructive cardiomyopathy：a short-term safety and efficacy study","authors":"Aiju Tian, Tianjing Zhang, Yuhe Jia, Jun Liu, Xiaogang Guo, P. Fang, Min Tang, Keping Chen, Yan Yao","doi":"10.1097/ms9.0000000000002243","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002243","url":null,"abstract":"\u0000 \u0000 Syncope is a serious consequence in patients with hypertrophic obstructive cardiomyopathy (HOCM). Percutaneous endocardial septal radiofrequency ablation (PESA) has emerged as a promising intervention to alleviate symptoms and enhance the quality of life for HOCM patients. However, little is known about the effects of PESA on syncope in HOCM. We aimed to study the effects of PESA on syncope in patients with HOCM.\u0000 \u0000 \u0000 \u0000 Nineteen patients with HOCM and syncope were enrolled. The left ventricular outflow tract gradient (LVOTG) of the patients was more than 50 mmHg despite medication. The participants underwent PESA under the guidance of intracardiac echocardiography (ICE) combined with a three-dimensional electrophysiological mapping system. The patients were followed for 3 (3-5.5) months.\u0000 \u0000 \u0000 \u0000 The mean age of the patients was 54.8±13.7 years. Out of the 19 participants, 7 (37%) were females. During the follow-up, the syncope was completely alleviated in 14 patients (73.7%) or the syncope episodes were reduced ≥ 80% in 16 patients (84.2%). The mean NYHA functional class significantly improved from 2.2±0.7 at baseline to 1.7±0.6 during follow-up (P=0.002).The LVOTG and septal thickness showed a decreasing trend from baseline to follow-up (LVOTG: P=0.083, septal thickness: P=0.086).\u0000 \u0000 \u0000 \u0000 Our investigation provides evidence supporting the effectiveness of PESA in reducing syncope episodes in patients with HOCM.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"6 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Apixaban versus low molecular weight heparin in patients with cancer associated venous thromboembolism: A systematic review and meta analysis","authors":"Anam Amin, Muhammad Omar Naeem, Laraib Amin, S. U. Khaliq, Athar Ahmad, R. R. Vohra, Sayed Jawad","doi":"10.1097/ms9.0000000000002147","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002147","url":null,"abstract":"\u0000 \u0000 Optimal treatment regimen for patients with cancer-associated venous thromboembolism (CA-VTE) remain unclear. Therefore, we sought to compare the outcomes of (VKAs) versus direct apixaban and low molecular weight heparin (LMWH) in patients with CA-VTE.\u0000 \u0000 \u0000 \u0000 MEDLINE, Embase, and Cochrane Central databases were searched for randomized controlled trials (RCTs) and observational studies comparing efficacy and safety of apixaban and LMWH in patients with CA-VTE. Major bleeding, clinically relevant non major bleeding (CRNMB), recurrence of pulmonary embolism (PE), deep venous thrombosis (DVT) and bleeding related mortality were among outcomes of interest. Mantel-Haenszel weighted random-effects model was used to calculate relative risks (RRs) with 95 percent confidence intervals (CIs).\u0000 \u0000 \u0000 \u0000 The analysis included 12011 patients from 3 RCTs and 2 observational studies. Compared to LMWH, apixaban significantly decreased the risk of major bleeding (RR 0.67 [95% CI 0.54, 0.83]; P=0.0003, I2=0%) without significantly changing the risk of clinically relevant non major bleeding (RR 0.96 [95% CI 0.64, 0.1.45]; P=0.85, I2=57%). Patients on apixaban had a noticeably reduced the risk of recurrence of PE than those taking LMWH, according to a meta-analysis (RR 0.56 [95% CI 0.32, 0.99]; P=0.05, I2=0%). There was no discernible difference between apixaban and LMWH in bleeding related mortality events (RR 0.20 [95% CI 0.01, 4.18]; P=0.30, I2=NA%), and recurrence of DVT (RR 0.60 [95% CI 0.22, 1.59]; P=0.23, I2=32%),\u0000 \u0000 \u0000 \u0000 Due to its lower risk of severe bleeding and reduced PE recurrence, apixaban may be a preferable treatment option for CA-VTE, but additional research is required to validate these conclusions and evaluate its long-term efficacy and safety.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141266740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of CT in acute bowel obstruction due to a supravesical hernia, a case report from Nepal","authors":"Anup Panthi, Ishwor Thapaliya, Laxman Khadka, M. Bhusal, Santosh Dev, Sanjeeb Kumar Jha, Anand Neupane, J. Sah","doi":"10.1097/ms9.0000000000002222","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002222","url":null,"abstract":"\u0000 \u0000 Supravesical hernias are rare internal hernias but potential cause of small bowel obstruction. The clinical features are often non-specific, preoperative diagnosis is very difficult and is often diagnosed intraoperatively. The exact pathogenesis is unclear with the major risk factors of prematurity, a positive family history, male gender, smoking habits leading to decreased collagen production, advancing age, and conditions characterized by defective collagen synthesis\u0000 \u0000 \u0000 \u0000 We are reporting a case of small bowel obstruction secondary to a supravesical hernia, in a 78-year-old male presented with central abdominal pain, vomiting and obstipation. Ultrasonography of the abdomen and pelvis identified a marked dilation of the small bowel loop with multiple loops of dilated jejunum and ileum in contrast-enhanced CT scan of the abdomen and pelvis with lead point from the terminal ileum. Exploratory laparotomy was done with the diagnosis of left posterior a left posterior superior vesical hernia with small bowel obstruction.\u0000 \u0000 \u0000 \u0000 The case focuses supravesical hernia as a rare yet life-threatening etiology of small bowel obstruction, emphasizing the importance of clinical suspicion when patients present with signs and symptoms of bowel obstruction. While diagnosis often occurs intraoperatively, the utilization of computed tomography (CT) scans in emergency settings can provide valuable insights into the location, potential causes, and condition of the herniated bowel sac. The case highlights the pivotal role of computed tomography (CT) scans in diagnosis and emphasizes the need for multidisciplinary cooperation among clinicians, radiologists, and surgeons.\u0000 \u0000 \u0000 \u0000 Early intervention ensures better outcomes and prevents irreversible bowel damage, underscoring the importance of a comprehensive approach to patient care.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"32 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a delayed chronic subdural hematoma 3 years after traumatic brain injury with urinary incontinence: A case report","authors":"Muhammad Sameer Khulsai, H. S. Nasir, Huda Raja, Abdullah Nadeem, Nahid Raufi, Atiq Ahmed Khan","doi":"10.1097/ms9.0000000000002221","DOIUrl":"https://doi.org/10.1097/ms9.0000000000002221","url":null,"abstract":"\u0000 \u0000 We present a case of a delayed chronic subdural hematoma, a rare occurrence that manifested three years after a traumatic brain injury, accompanied by an unexpected symptom of urinary incontinence. Chronic subdural hematoma (CSDH) is a well-known condition characterised by the accumulation of old, liquefied blood under the dura mater, usually following minor head trauma. However, the atypical presentation of CSDH in a young patient without predisposing factors and the association with urinary incontinence challenge conventional understanding. This report explores the clinical manifestations, radiological findings, and management of this exceptional case, providing valuable insights into this unusual presentation.\u0000 \u0000 \u0000 \u0000 In this report, we present the case of a 23-year-old male with an unremarkable medical history, devoid of prior neurological deficits, who presented with persistent headaches, memory impairment, left-right disorientation, slurred speech, and urinary incontinence, troubling him for the past month. The patient had a history of a traumatic brain injury from a road traffic accident three years earlier, initially devoid of concerning symptoms. Imaging revealed a large heterogeneous mass lesion in the left fronto-parietal lobe consistent with a chronic subdural hematoma. The patient underwent surgical evacuation and excision of the hematoma, leading to the successful resolution of symptoms.\u0000 \u0000 \u0000 \u0000 Conventionally, chronic subdural hematoma is observed in elderly individuals following minor head trauma. However, this case challenges the traditional understanding by highlighting its delayed occurrence in a young patient without known predisposing factors. This case emphasises the need to consider delayed presentations even without immediate neurological deficits. The unexpected symptom of urinary incontinence underscores the necessity of comprehensive evaluations to understand the associated neurological effects of CSDH. A surgical approach was crucial for both diagnosis and treatment, underscoring the significance of prompt intervention in such atypical cases.\u0000 \u0000 \u0000 \u0000 This exceptional case sheds light on a delayed chronic subdural hematoma occurring years after traumatic brain injury in a young patient without known risk factors. The presence of urinary incontinence as a symptom further amplifies the uniqueness of this case. Understanding and recognising atypical presentations of CSDH is vital for accurate diagnosis and timely intervention. This report underscores the importance of vigilance and an integrated approach to managing patients with subdural hematomas, particularly in unexpected demographics and circumstances, to ensure optimal outcomes and patient well-being.\u0000","PeriodicalId":373451,"journal":{"name":"Annals of Medicine & Surgery","volume":"36 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141098153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}