Archive of clinical cases最新文献

{"title":"Pneumocephalus and delayed hydrocephalus following endoscopic endonasal biopsy of skull base lesion: diagnostic pitfalls and the role of immunohistochemistry.","authors":"Adil Ugur Yavuz, Mehmet Aktoklu, Eda Altunbag Yavuz, Ugur Yazar","doi":"10.22551/2026.50.1301.10333","DOIUrl":"https://doi.org/10.22551/2026.50.1301.10333","url":null,"abstract":"<p><p>The endoscopic endonasal approach (EEA) has been increasingly utilized for interventions involving the middle cranial base because of its close anatomical relationship with the nasal cavity and nasopharynx. This technique is widely applied in neurosurgical and otorhinolaryngological practice for the management of pituitary lesions, sellar and parasellar pathologies, sphenoid sinus tumors, cavernous sinus lesions, and tumors of the nasal cavity and nasopharynx, offering improved surgical access and patient comfort. Endoscopic procedures may be associated with serious complications, including intracranial hemorrhage, pneumocephalus, cerebrospinal fluid (CSF) leakage, infection, and cranial nerve injury, which can occur in both early and late postoperative periods. We report a patient who developed early postoperative pneumocephalus, intracerebral hemorrhage, and CSF leakage following endoscopic endonasal biopsy of a lesion adjacent to the mid-cranial base. Based on clinical and radiological findings, the lesion was initially suspected to represent nasopharyngeal carcinoma. Therefore, the patient underwent an endoscopic endonasal biopsy rather than gross total resection. Histopathological and immunohistochemical analyses subsequently established the diagnosis of meningioma. Two weeks postoperatively, the patient developed CSF leakage, pneumocephalus, and intracerebral hemorrhage, and the skull base defect was repaired via an EEA. Subsequently, the patient developed hydrocephalus in the mid-to-late postoperative period, which was successfully treated with ventriculoperitoneal shunt placement, resulting in complete clinical recovery. This case highlights the need for close clinical and radiological follow-up not only in the early period but also in the mid-to-late postoperative periods. Furthermore, radiological findings suggestive of malignancy may be inconsistent with immunohistochemical results; this underscores the critical role of immunohistochemical examination in determining definitive diagnosis and prognosis.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"13 1","pages":"5-10"},"PeriodicalIF":0.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846825","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}

{"title":"Total occlusive thrombosis of the abdominal aorta following holmium laser lithotripsy and ureteroscopy.","authors":"Tawfiq Almezeiny","doi":"10.22551/2026.50.1301.10335","DOIUrl":"https://doi.org/10.22551/2026.50.1301.10335","url":null,"abstract":"<p><p>Abdominal aortic thrombosis (AAT) is a rare condition with substantial morbidity and mortality risk if not treated promptly. AAT typically occurs in postoperative patients, particularly those with certain risk factors. Here, we present the case of a urology patient who underwent ureteroscopy and laser lithotripsy for ureterolithiasis. During the postoperative period, the patient was re-admitted with a massive intra-abdominal arterial thrombosis involving the iliac and renal arteries and abdominal aorta. Emergency thrombectomy, angioplasty, and catheter-directed thrombolysis were performed in multiple stages. After a complex postoperative course in the intensive care unit, the patient survived and was discharged in stable condition.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"13 1","pages":"15-18"},"PeriodicalIF":0.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142661/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846800","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}

{"title":"Recurrent spatial disorientation and amnestic episodes associated with lung adenocarcinoma: a serum- and CSF-negative paraneoplastic case.","authors":"Jing Huang, Bo Zuo, Yanhui Shi, Jiansheng Liu, Junwen Li, Wenwei Li","doi":"10.22551/2026.50.1301.10334","DOIUrl":"https://doi.org/10.22551/2026.50.1301.10334","url":null,"abstract":"<p><p>Recurrent seizure-like episodes with preserved motor function and negative conventional investigations pose a significant diagnostic challenge, particularly in elderly patients. We report an elderly patient presenting with recurrent, stereotyped episodes of spatial disorientation and amnesia. Extensive evaluation, including brain MRI, cerebrospinal fluid analysis, electroencephalography, serum tumor markers, and neuronal antibody testing, was unrevealing. The patient did not meet the 2016 criteria for possible autoimmune encephalitis. A previously monitored pulmonary nodule was surgically resected and confirmed as lung adenocarcinoma. Remarkably, neurological episodes completely resolved following tumor resection and did not recur after discontinuation of antiseizure medication during 10 months of follow-up. This case highlights a potential tumor-related seizure-associated network dysfunction in the absence of detectable antibodies or overt limbic inflammation. Careful tumor evaluation should be considered in similar diagnostic dilemmas, even when conventional autoimmune markers are negative.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"13 1","pages":"11-14"},"PeriodicalIF":0.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846748","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}

{"title":"Transvaginal dialysate leak via patent fallopian tubes following peritonitis in a CAPD patient.","authors":"Zhi Ying Tan, Abosede Bankole","doi":"10.22551/2026.50.1301.10332","DOIUrl":"https://doi.org/10.22551/2026.50.1301.10332","url":null,"abstract":"<p><p>Transvaginal leakage of peritoneal dialysate is an uncommon non-infectious complication of peritoneal dialysis (PD) and may be overlooked in female patients presenting with unexplained vaginal fluid loss. A 78-year-old woman with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) presented with a one-week history of clear per vaginal leakage. This episode developed following an initial presentation of PD peritonitis for which she was receiving antibiotic therapy. She reported the onset of clear vaginal leakage during a routine clinic visit for monitoring of her vancomycin level, prompting her admission for further evaluation. On clinical examination, the patient was afebrile and hemodynamically stable. Abdominal examination was satisfactory, however, speculum examination showed pooling of clear fluid in the vagina without evidence of vaginal or cervical pathology. Subsequent CT peritoneography demonstrated contrast-filled dialysate tracking from the peritoneal cavity, passing through bilaterally patent fallopian tubes into both the endometrial and vaginal cavities. Interestingly, there was no evidence of vaginal wall perforation or an abnormal fistulous connection identified. Given the absence of a correctable fistulous tract, PD was discontinued and the patient was transitioned to hemodialysis, resulting in complete resolution of symptoms. Although rare, physiological tubal patency can provide a conduit for dialysate leakage in PD patients, particularly following recent peritonitis. This mechanism is especially uncommon in post-menopausal women, highlighting the novelty of this case. Clinicians should maintain a high index of suspicion for this rare complication in women presenting with new-onset vaginal fluid loss. Early recognition and appropriate modality change may prevent recurrence.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"13 1","pages":"1-4"},"PeriodicalIF":0.6,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13142662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846776","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}

{"title":"Thrombotic thrombocytopenic purpura in a patient with systemic lupus erythematosus after anifrolumab: a possible association.","authors":"Albader Hamza Hussein, Mohamed E Badran, Bayan Lafi Altamimi","doi":"10.22551/2025.49.1204.10330","DOIUrl":"10.22551/2025.49.1204.10330","url":null,"abstract":"<p><p>Anifrolumab, an inhibitor of the type I interferon receptor, is increasingly used for moderate to severe systemic lupus erythematosus (SLE). Although clinical trials report a favorable safety profile, real-world data remain limited. A 32-year-old woman with long-standing SLE developed fever, mucocutaneous bleeding, confusion, and seizures approximately ten weeks after initiating anifrolumab. Laboratory evaluation demonstrated microangiopathic hemolytic anemia, severe thrombocytopenia, elevated lactate dehydrogenase, and markedly reduced ADAMTS13 activity (10%). Other causes of thrombotic microangiopathy were excluded. The patient received plasma exchange, corticosteroids, caplacizumab, and rituximab, resulting in full neurologic and hematologic recovery. The close temporal relationship between anifrolumab initiation and onset of immune-mediated thrombotic thrombocytopenic purpura raises a possible drug-related association, although causality cannot be established from a single case. Clinicians should remain vigilant for new cytopenia or neurologic symptoms in patients starting interferon-pathway-targeted biologic therapy. Further pharmacovigilance is required to determine whether this represents a coincidental occurrence or a signal of potential risk.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 4","pages":"154-156"},"PeriodicalIF":0.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12814899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013543","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}

{"title":"Electrocardiogram peaked T-waves in a patient with reverse Takotsubo syndrome.","authors":"John E Madias","doi":"10.22551/2025.49.1204.10331","DOIUrl":"10.22551/2025.49.1204.10331","url":null,"abstract":"","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 4","pages":"157"},"PeriodicalIF":0.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12814900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013569","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}

{"title":"Internal limiting membrane detachment associated with papilloedema following brain metastasis in a child with Ewing sarcoma.","authors":"Ayse Ebru Bahadir, Dilek Guven, Ozgul Altintas","doi":"10.22551/2025.49.1204.10329","DOIUrl":"10.22551/2025.49.1204.10329","url":null,"abstract":"<p><p>This case report presents initial and follow-up findings of a rare case of bilateral internal limiting membrane (ILM) detachment and sub-ILM hemorrhage in a 7-year-old child with Ewing sarcoma, associated with papilloedema due to a brain metastasis and the use of optical coherence tomography (OCT) in the evaluation and follow-up. The child was diagnosed with Ewing sarcoma and she was referred to the ophthalmology clinic because of blurry vision, anisocoria, and strabismus one week after the operation for brain metastasis. Fundus examination showed bilateral grade IV papilloedema, well-defined dome-shaped area extending towards the optic discs with inferiorly located hemorrhage. OCT revealed bilateral ILM detachment surrounded with a ring-shaped retinal elevation and inferiorly located sub-ILM hemorrhage. On the follow-up examinations OCT showed decrease of height of ILM detachment with resolution of sub-ILM hemorrhage. ILM detachment associated with papilloedema due to a brain metastasis is an exceedingly rare occurrence, making this case particularly significant in understanding ocular manifestations of intracranial pathology. OCT plays a crucial role in diagnosing and monitoring the progression of ILM detachment and associated sub-ILM hemorrhage, offering invaluable insights into the pathophysiology of raised intracranial pressure. Recognizing ocular signs such as papilloedema is critical for early detection of intracranial complications in pediatric patients.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 4","pages":"148-153"},"PeriodicalIF":0.6,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12814898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146013577","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}

{"title":"Systemic Lupus Erythematosus in a patient with Aquaporin 4-Positive Neuromyelitis Optica Spectrum Disorder.","authors":"Swagat Saha","doi":"10.22551/2025.48.1203.10326","DOIUrl":"10.22551/2025.48.1203.10326","url":null,"abstract":"<p><p>A 27-year-old female presented with a rapidly progressive demyelinating syndrome with anti aquaporin-4 (AQP4) antibodies, initially diagnosed as neuromyelitis optica spectrum disorder (NMOSD). A comprehensive evaluation, prompted by systemic symptoms including chronic polyarthralgia, bicytopenia, and a history of recurrent pregnancy loss, revealed a concurrent diagnosis of systemic lupus erythematosus (SLE), confirmed by positive antinuclear (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. The co-occurrence of AQP4-positive NMOSD and SLE is a rare but well-documented clinical phenomenon that presents a unique diagnostic and therapeutic challenge. This also highlights the need for a thorough rheumatological assessment to identify underlying systemic autoimmune diseases in atypical neurological presentations with extra-neurological signs.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 3","pages":"132-135"},"PeriodicalIF":0.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208610","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}

{"title":"Insulinoma initially misdiagnosed as migraine.","authors":"Javeria Hameed, Irbaz Ahmed, Abed M Zaitoun, Ammar Salman Syed, Claudia Santos, Carolyn Chee","doi":"10.22551/2025.48.1203.10325","DOIUrl":"10.22551/2025.48.1203.10325","url":null,"abstract":"<p><p>Insulinoma is a rare functional neuroendocrine tumor of pancreatic islet cells that produces excessive insulin leading to neuroglycopenic and autonomic symptoms relieved by glucose. We report a case of a 39-year-old woman with recurrent neuroglycopenic symptoms for nearly five years, initially misdiagnosed as migraine, until she presented to ED with a collapse secondary to hypoglycemia. Biochemical confirmation was obtained during a supervised 72-hour fast, with symptomatic hypoglycemia which showed lowest glucose levels of 1.7mmol/L, elevated C-peptide levels of 2,271pmol/L, high insulin levels of 83.5 mU/L and a negative sulfonylurea screen. Imaging demonstrated a large hyper enhancing pancreatic mass, confirmed by ⁶⁸Ga-DOTATATE PET as a solitary lesion without metastasis. Histopathology revealed a well-differentiated Grade 1 neuroendocrine tumor measuring 90×65×40 mm. Following surgical intervention, she demonstrated a successful recovery. This case emphasizes the need to consider insulinoma early in the differential diagnosis of recurrent neuroglycopenic episodes to prevent serious complications and avoid inappropriate treatments.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 3","pages":"127-131"},"PeriodicalIF":0.6,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12481506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208580","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}

{"title":"Psychosis-predominant neuropsychiatric lupus in a severely malnourished adolescent: a diagnostic challenge.","authors":"Manu Dwivedi, Muhammad Azaz Iftikhar Cheema, Zoha Ghuman, Asma Iftikhar","doi":"10.22551/2025.48.1203.10327","DOIUrl":"10.22551/2025.48.1203.10327","url":null,"abstract":"<p><p>Neuropsychiatric systemic lupus erythematosus (NPSLE) is a rare but severe manifestation of systemic lupus erythematosus in adolescents, with psychosis-predominant presentations occurring in approximately 5-12% of pediatric cases. Such manifestations may precede or obscure classic systemic features, often resulting in diagnostic delays and initial misattribution to primary psychiatric or infectious etiologies. We present the case of a previously healthy 19-year-old female who developed acute psychosis characterized by paranoia, auditory hallucinations, disorganization, and suicidal ideation over five days. Immunosuppressive therapy was initiated with pulse-dose methylprednisolone, followed by intravenous immunoglobulin and rituximab. Early consideration of autoimmune etiologies and a multidisciplinary approach, including rheumatology, psychiatry, neurology, and nutrition, are essential to optimize outcomes in this vulnerable population. The patient's limited psychiatric response despite immunologic improvement underscores the delicate balance between prompt immunosuppression and the neuropsychiatric risks associated with corticosteroid therapy. This case highlights the diagnostic challenges of psychosis-predominant NPSLE in adolescents complicated by nutritional and infectious factors, whilst emphasizing the importance of early recognition of autoimmune etiologies and multidisciplinary management for optimal outcomes.</p>","PeriodicalId":72274,"journal":{"name":"Archive of clinical cases","volume":"12 3","pages":"136-139"},"PeriodicalIF":0.6,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12581184/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446589","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}