The eight-and-a-half syndrome (EHS)—defined by the combination of a seventh cranial nerve palsy and an ipsilateral one-and-a-half syndrome—is a rare brainstem syndrome, which localises to the caudal tegmental region of the pons. We present a case of the EHS secondary to an inflammatory lesion on a previously healthy 26-year-old woman, with a literature review emphasising the relevance of aetiological assessment.
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Splenic injury after colonoscopy is a rare (1:100 000) but serious complication after colonoscopy associated with high morbidity. Consequences range from a mild, self-limited splenic haematoma to the catastrophic shattered spleen and haemorrhagic shock. We present a case of a 68-year-old woman reporting to the emergency department with abdominal pain after colonoscopy. Abdominal CT with intravenous contrast showed a grade I splenic laceration with no active bleeding and a small amount of free fluid...
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A 17-year-old man with no significant medical history presented with new-onset seizure activity and altered mental status manifesting as bizarre behaviour, which included rapid pressured and tangential speech, psychomotor agitation, insomnia and delusions. He also had autonomic dysregulation, manifested in labile blood pressures. He had been recently discharged from his first psychiatric hospitalisation. Many studies were performed, including electroencephalogram (EEG), head CT, laboratory work,...
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Uterine artery pseudoaneurysm in pregnancy is a dangerous condition as rupture can be catastrophic due to the large volume of uterine blood flow. We present a case of a healthy, young woman with a desired pregnancy at 15 weeks of gestation incidentally discovered to have a pseudoaneurysm of the uterine artery during a routine prenatal ultrasound. She underwent initial thrombin injection followed by endovascular coil embolisation of the left uterine artery and carried the pregnancy to term without...
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Angiosarcomas account for less than 1% of primary breast cancers. Typically, they occur in young women with a low-risk personal or family history. Diagnosis, resection and reconstruction require a multidisciplinary team of breast surgeons, oncologists and plastic reconstructive surgeons. Cross-disciplinary awareness among these specialities enables dimensional patient treatment. We report a case of primary angiosarcoma of the breast in a 33-year-old woman, with no previous radiotherapy exposure,...
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The first case is a 45-year-old man who presented with complaints of right-sided indirect hernia. On examination the left hemiscrotum was empty. Open hernioplasty and mesh fixation with orchiopexy of both testes were done in the same hemiscrotum, followed by MRI for further evaluation. The second case is a 26-year-old man who presented with penoscrotal hypospadias and empty left hemiscrotum, with the left testis not palpable in the scrotum or the inguinal region. MRI, karyotyping and laparoscopic...
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We report a patient who has been on tacrolimus for bilateral lung transplantation and presented with a brachial plexus injury (BPI), with unusual improvement of lower trunk innervated hand function. The lower trunk injury with resultant left hand paralysis had developed after his sternotomy 18 months ago. He has been treated with tacrolimus as part of his immunosuppression protocol since the surgery, without severe side effects. Physical examination at 18 months demonstrated unusual excellent grip...
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A 54-year-old Chinese woman presented for radiofrequency ablation (RFA) of benign thyroid nodules. A few hours after the procedure, the patient developed neck swelling and tenderness. Doppler ultrasound (US) images of the neck revealed haematoma with a vascular hypoechoic mass at the RFA site, suspicious for pseudoaneurysm. These findings were confirmed on subsequent on-table fluoroscopy following direct US-guided needle puncture and injection of contrast, demonstrating opacification of the mass...
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Although sickle cell disease has long been viewed as a contraindication to free flap transfer, little data exist evaluating complications of microsurgical procedures in the sickle cell trait patient. Reported is the case of a 55-year-old woman with sickle cell trait who underwent a deep inferior epigastric perforator microvascular free flap following mastectomy. The flap developed signs of venous congestion on postoperative day 2 but was found to have patent arterial and venous anastomoses on exploration...
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Bilateral agenesis of the long head of the biceps brachial tendon (LHB) is a very rare variation of the anatomy. We report a case of an 18-year-old man with bilateral agenesis of the long head of the biceps brachii tendon. We present initial findings, radiographical examinations and the follow-up of an unusual entity. Diagnosis of agenesis of the LHB can be challenging especially in cases of traumatic shoulder pain. It is not a very known entity because of its rareness. However, it could be associated...
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Orbital infarction syndrome (OIS) encompasses the ischaemic infarction of all intraorbital and intraocular structures (optic nerve, extraocular muscles and orbital fat) which leads to a painful loss of visual acuity, ophthalmoparesis, chemosis, proptosis and ptosis. The rich anastomotic orbital vascularisation from internal carotid artery (ICA) and external carotid artery makes this disorder a rare cause of visual loss in stroke patients. We describe a case of a woman who suffered an acute occlusion...
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A 15-year-old patient with sickle cell disease with recessive homozygous haemoglobin S/HbSS suffered several crises developmentally after the last of which the patient fell into coma. CT scan then revealed a large infarct of the right cerebral hemisphere. Three weeks after the event, the patient began to demonstrate spontaneous eye opening and spastic quadriparesis with no evidence of command-following, gestural or verbal communication, visual pursuit or purposeful motor behaviour. Our case was in...
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Haemophagocytic lymphohistiocytosis (HLH) can be a rapidly fatal disease. Current treatment in adults is extrapolated from the HLH-2004 protocol that specifies a regimen of etoposide, dexamethasone and cyclosporine. However, HLH presents as a spectrum of disease severity. A therapeutic challenge arises for milder cases where the harms of potent chemotherapy such as etoposide may outweigh its benefit. We present a case of an adult with HLH who developed significant pancytopenia but was otherwise not...
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Primary hepatic tuberculosis is a rare clinical entity with non-specific clinical and imaging features that can mimic other liver diseases, representing a diagnostic challenge. We report a case of a 35-year-old man with metabolic syndrome, type 2 diabetes and high alcohol consumption presenting asymptomatic with abnormal liver tests, hepatosplenomegaly and diffuse hepatic steatosis in ultrasound imaging initially suspected to be alcoholic steatohepatitis but later diagnosed as hepatic tuberculosis...
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Aortic dissection is an uncommon diagnosis that typically presents with acute onset of severe pain. It rarely presents with minimal to no symptoms, which carries a higher mortality risk given the delay in diagnosis. An adequate interpretation of risk factors, clinical findings and auxiliary tests constitutes a greater value for clinicians to detect this life-threatening condition. This report describes a case of type A aortic dissection in an asymptomatic patient presenting with an abnormal electrocardiogram...
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A 26-year-old man presented to emergency department with respiratory distress. The initial diagnosis after chest X-ray was massive haemothorax, after insertion of a chest drain and further investigations, it turned up to be a rare case of a delay presentation of traumatic diaphragmatic rupture (DR) (after 1 year of the initial trauma). After excessive resuscitation of the patient in the emergency department, the patient underwent an emergency laparotomy which revealed ischaemic transverse colon herniated...
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