Oxford Medical Case Reports最新文献

Background: Focal dystonia is an uncommon movement disorder that may emerge secondary to structural brain lesions. This report presents a rare case of delayed-onset, levodopa-responsive hemidystonia following a brainstem hemorrhage with suspected disruption of the nigrostriatal pathway.

Case report: A 58-year-old man developed sustained dystonic posturing of the left upper and lower limbs one year after suffering a right-sided pontine-midbrain hemorrhage. MRI demonstrated hypointensities in the right substantia nigra and red nucleus, consistent with hemosiderin deposition. Levodopa was initiated at 300 mg/day and titrated to 600 mg/day over 4 weeks, resulting in marked symptomatic improvement. No craniofacial dystonia or parkinsonism was observed.

Discussion: Delayed-onset dystonia can arise from secondary degeneration or iron deposition within the nigrostriatal system. This case highlights the importance of advanced imaging and therapeutic trial of dopaminergic agents in post-lesional dystonia. Literature review indicates similar pathophysiological mechanisms in post-stroke dystonia, although levodopa-responsiveness is rarely reported.

A woman in her 60s presented with a three-week history of progressive subacute back pain without neurological deficits. MRI of the lumbar spine demonstrated necrosis at the L3-L4 disc and adjacent vertebral bodies, raising suspicion for malignancy or infection. Two image-guided bone biopsies were nondiagnostic. A peripheral infectious disease workup was similarly unremarkable. Owing to the persistent concern for infection, 16S ribosomal RNA sequencing was performed on biopsy samples, which identified Capnocytophaga canimorsus. Only after receiving this result did the patient recall a minor dog bite sustained six weeks prior to symptom onset. She was managed with an extended course of oral antibiotics with complete clinical recovery. This case illustrates the capacity of C. canimorsus to cause insidious vertebral osteomyelitis in immunocompetent individuals, underscores the diagnostic utility of 16S rRNA sequencing in culture-negative infections, and highlights the critical importance of a detailed exposure history in atypical clinical presentations.

Radioulnar synostosis is a rare but severe complication of pediatric forearm trauma that results in the loss of forearm rotation and functional impairment. We report the case of a 7-year-old boy who developed post-traumatic distal radioulnar synostosis following a high-energy road traffic accident. Initial management involved open reduction and internal fixation of both forearm bones. One year later, due to loss of pronation-supination, the child underwent revision surgery with bony bridge resection and interposition. Sixteen months after the second surgery, the outcome was excellent with full restoration of forearm rotation and no recurrence. This case highlights the diagnostic and therapeutic challenges in pediatric synostosis and supports the role of early surgical resection with interposition for optimal results.

Background: Primary hyperparathyroidism due to overproduction of parathyroid hormone may present with fatigue, renal stone, abdominal pain, constipation; However, it is rare to observe a pathological fracture as the initial manifestation. We present a case of a young woman with multiple fractures, highlighting the diagnostic challenge. Case presentation: A 35-year-old woman was presented with pain, swelling, and restricted movement in her right upper limb and unable to stand after a minor fall. Initially, she received treatment in the orthopedics department for fractured right humerus and both shaft of femur, then transferred to the medicine department for further evaluation. Serum parathyroid and calcium levels were elevated. A 99m TC MIBI parathyroid SPECT-CT scan revealed persistence of the intense focal radiotracer concentration at right lobe thereby confirming a lower right parathyroid adenoma. Conclusions: This case underscores the potential for primary hyperparathyroidism to manifest with atypical symptoms, leading to delayed diagnosis and management.

Urethral prolapse is a rare and often underdiagnosed condition characterized by circumferential eversion of the distal urethra through the external urethral meatus, forming a doughnut-shaped protrusion. We present the case of a 34-month-old girl who was brought to the pediatric emergency unit by her parents following the discovery of bloodstains on her underwear. Clinical examination revealed a reddish, fleshy, doughnut-shaped mass measuring approximately 2.0 × 1.5 cm surrounding the urethral meatus, located above the vaginal introitus and beneath the clitoral hood. She was managed conservatively with oral cefixime suspension (4 mg/kg/day), ibuprofen, sitz baths, and topical estrogen cream. By the fourth day, the bleeding had completely resolved. The prolapsed mass was significantly reduced in size after two weeks and resolved entirely by the sixth week, without residual symptoms. This case highlights the importance of considering urethral prolapse as a differential diagnosis in cases with vaginal bleeding in prepubertal girls.

Peritonitis remains a serious complication in patients undergoing peritoneal dialysis, often caused by common organisms such as Staphylococcus aureus. However, rare pathogens may also play a role. We report a case of peritonitis in a 41-year-old female on continuous ambulatory peritoneal dialysis, in whom Pluralibacter gergoviae was identified as the causative organism. The patient presented with abdominal pain and cloudy dialysate but remained hemodynamically stable. Peritoneal fluid analysis revealed elevated white cell counts, and culture Pluralibacter gergoviae, which was sensitive to multiple antibiotics. Initial empiric therapy was adjusted accordingly, leading to clinical and laboratory improvement. This is the second reported case of Pluralibacter gergoviae-related peritonitis in the literature. This case underscores the importance of recognizing uncommon pathogens in peritoneal dialysis-related infections and the role of prompt microbiological diagnosis in guiding targeted therapy. Increased awareness and reporting of such cases are essential to enhance understanding and optimize patient management.

Silver-Russell syndrome (SRS), also known as Russell-Silver syndrome (RSS), is a congenital growth disorder characterized by intrauterine and postnatal growth retardation, craniofacial disproportion, asymmetry, and other distinctive features. It was first described by Alex Russell and Henry Silver in the 50s of the 20th century. Its broad range of manifestations makes its true incidence difficult to determine. While gastrointestinal anomalies such as gastroesophageal reflux disease and esophagitis have been reported in SRS patients, an association with colorectal cancer (CRC) has not been described. Here, we present the case of a 31-year-old man with SRS who was referred to us for constipation. A rectal biopsy revealed moderately differentiated adenocarcinoma, and a staging CT scan demonstrated multiple lung and hepatic nodules.

Medial Pontomedullary Junction (MPMJ) infarction is an uncommon cerebrovascular event with distinctive clinical presentations that often mimic benign conditions, such as Bell's palsy, complicating early diagnosis. This case report describes a 43-year-old female presenting with acute facial droop, dysarthria, dysphagia, and sensory deficits suggestive of Bell's palsy. Despite an unremarkable initial CT scan, advanced imaging with MRI revealed a left MPMJ infarction, highlighting the critical role of diffusion-weighted imaging (DWI) in detecting brainstem lesions. The clinical features of lower motor neuron facial palsy, contralateral sensory deficits, and dysphagia distinguish MPMJ infarction from peripheral facial nerve disorders. Risk factors such as poorly controlled hypertension and diabetes likely contributed to arterial compromise in this patient. This report highlights the need for detailed neurological assessments and advanced imaging to accurately diagnose and manage atypical brainstem strokes, reducing severe morbidity risks.

A 30-year-old female farmer from South-West Shewa, Ethiopia, presented with chest and abdominal pain. Imaging revealed concomitant pulmonary and hepatic cystic echinococcosis, with calcified liver cysts showing the classic cerebral gyri sign. According to WHO guidelines, pulmonary surgery was advised, while hepatic cysts warranted observation. Serology was unavailable, and the patient was lost to follow-up. This case highlights imaging as a key diagnostic tool and the need for preventive education in endemic settings.

Cannabis use has been increasingly associated with cerebrovascular events, though simultaneous large-vessel occlusions in both anterior and posterior circulations are rare. We report a case involving a 50-year-old male with no medical history who presented with decreased consciousness and left-sided hemiplegia. CT angiography imaging revealed acute occlusion of the right middle cerebral artery (MCA) and the basilar artery. Urine toxicology was positive for cannabis. Extensive cardiac and laboratory workups were unremarkable. The patient underwent successful mechanical thrombectomy, achieving full reperfusion (TICI 3) without complications. With no identifiable alternative cause and a history of chronic cannabis use, a diagnosis of cannabis-associated large-vessel ischemic stroke was made. To our knowledge, this is the first reported case of concurrent MCA and basilar artery occlusions in this context. This case highlights the need for increased awareness of cannabis as a potential risk factor for multi-territory ischemic stroke, particularly in patients without traditional vascular risk factors.