Acta clinica Croatica
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Pineal cysts occur in all ages, predominantly in adults in the fourth decade of life. In series of magnetic resonance imaging (MRI) studies, the prevalence of pineal cysts ranged between 1.3% and 4.3% of patients examined for various neurologic reasons and up to 10.8% of asymptomatic healthy volunteers. The diagnosis of pineal cyst is usually established by MRI with defined radiological criteria to distinguish benign pineal cyst from tumors of this area. ⋯ Symptomatic cysts vary in size from 7 mm to 45 mm, whereas asymptomatic cysts are usually less than 10 mm in diameter, although a relationship between the cyst size and the onset of symptoms has been proved to be irrelevant in many cases. There is agreement that surgical intervention should be undertaken in patients presenting with hydrocephalus, progression of neurologic symptoms, or cyst enlargement. Tissue sample of the pineal lesion can be obtained by open surgery, stereotaxy and neuroendoscopy.
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Acta clinica Croatica · Sep 2009
Case ReportsSpontaneous pneumomediastinum in a healthy adolescent.
Spontaneous pneumomediastinum is a rare clinical entity defined as the presence of free air in the mediastinal structures without an apparent cause such as trauma. Spontaneous pneumomediastinum is rare in children and most frequently occurs in young male patients. It usually develops after alveolar rupture and air penetration into the pulmonary interstice, followed by air penetration towards the hila and into the mediastinum. ⋯ A case is presented of pneumomediastinum in a 17-year-old male adolescent with no relevant history but with a clinical picture of intense retrosternal pain and subcutaneous emphysema of the neck and supraclavicular region. Thorough examinations including chest x-ray, chest computed tomography, bronchoscopy and esophagoscopy failed to identify the cause of pneumomediastinum. After eight days of conservative treatment, the pneumomediastinum symptoms completely disappeared and x-ray showed resolution of pneumomediastinum.
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The aim of the study was to determine whether an acute loss of consciousness, mental status change or related symptoms correlated with the presence of epileptiform abnormalities on urgent EEG. We analyzed 228 consecutive patients admitted to Emergency Room during the past 12 months and referred for urgent EEG evaluation. All patients had either a brief loss of consciousness or acute brain disorder, with a clinical diagnosis of epilepsy, syncope, head trauma, headache, transient ischemic attack (TIA) or vertigo. ⋯ In conclusion, epilepsy was the most common clinical diagnosis in patients referred for urgent EEG. There was a significant correlation between the diagnosis and specific EEG abnormalities, however, the diagnosis of epilepsy failed to predict epileptiform activity on EEG. Study results suggested urgent EEG to have a high yield in patients with epilepsy.
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Neuropathic pain refers to pain that originates from pathology of the nervous system. Common causes of neuropathic pain are diabetes mellitus, reactivation of herpes zoster, nerve compression or radiculopathy, alcohol, chemotherapy or abuse of some drugs, and trigeminal neuralgia. ⋯ The use of multiple drug therapies is common in practice. Despite considerable increase in the number of randomized placebo-controlled trials in neuropathic pain in the last few years, the medical treatment of neuropathic pain is still far from being satisfactory, with less than half of patients achieving significant benefit with any pharmacological drug.