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BACKGROUND: Neuromonitoring in medical intensive care units is challenging as most patients are unfit for invasive intracranial pressure (ICP) modalities or unstable to transport for imaging. Ultrasonography-based optic nerve sheath diameter (ONSD) is an attractive option as it is reliable, repeatable and easily performed at the bedside. It has been sufficiently validated in traumatic brain injury (TBI) to be incorporated into the guidelines. However, currently the data for non-TBI patients is inconsistent for a scientific recommendation to be made. AIM: To compile the existing evidence for understanding the scope of ONSD in measuring ICP in adult non-traumatic neuro-critical patients. METHODS: PubMed, Google Scholar and research citation analysis databases were searched for studies in adult patients with non-traumatic causes of raised ICP. Studies from 2010 to 2024 in English languages were included. RESULTS: We found 37 articles relevant to our search. The cutoff for ONSD in predicting ICP varied from 4.1 to 6.3 mm. Most of the articles used cerebrospinal fluid opening pressure followed by raised ICP on computed tomography/magnetic resonance imaging as the comparator parameter. ONSD was also found to be a reliable outcome measure in cases of acute ischaemic stroke, intracerebral bleeding and intracranial infection. However, ONSD is of doubtful utility in septic metabolic encephalopathy, dysnatremias and aneurysmal subarachnoid haemorrhage. CONCLUSION: ONSD is a useful tool for the diagnosis of raised ICP in non-traumatic neuro-critically ill patients and may also have a role in the prognostication of a subset of patients.
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Carotid cavernous fistula is a rare but clinically important vascular abnormality that is challenging to diagnose and treat. The clinical data of a patient with bilateral carotid cavernous fistula diagnosed by CT images were retrospectively analyzed. Through the analysis of CT images, the patient was accurately located and the diagnosis was confirmed. CT images can provide detailed anatomical information and accurately show the location, morphology and hemodynamic characteristics of carotid cavernous fistula. Through CT image examination, we successfully diagnosed bilateral carotid cavernous fistula patients, and can provide an important reference for surgical treatment. Therefore, CT image examination can provide accurate diagnosis and surgical planning information, and provide support for the formulation of individual treatment plans for patients. The application of this method is helpful to improve the early diagnosis rate and treatment effect of carotid cavernous fistula.
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Objectives This study aimed to characterize and compare the features of traumatic and non-traumatic lesions causing knee pain through magnetic resonance imaging (MRI). Method The study was conducted at a tertiary care center, with data sourced from patients visiting the outpatient and in-patient departments. It involved a descriptive cross-sectional research design focusing on patients referred for knee MRI scanning. The sample size was calculated using Cochran's formula as 112 for symptomatic patients with knee pain with a 95% confidence interval. The MRI findings in 112 patients were analyzed and associated with a history of trauma. Results The average age recorded was 35.38 years. Females made up 41.07% (n=46) of the sample, while males accounted for 58.93% (n=66). Among the participants, the majority (n=82; 71.43%) had a history of trauma, and the most common MRI finding was joint effusion (n=74; 66.1%). The second most common was anterior cruciate ligament (ACL) injuries (n=71; 63.4%), followed by meniscus injury (n=40; 35.71%). The study confirms that those with history of trauma are at a higher risk (p<0.05) of sustaining injuries like meniscus and ACL tears, collateral ligament damage, bone contusions, chondromalacia patella, and joint effusion. Conclusion In conclusion, the consistency of our findings with existing studies reinforces the pivotal role of MRI in the evaluation of knee pain. Despite its limitations, including cost and accessibility, MRI remains a gold standard for diagnosing a wide range of knee pathologies, offering unparalleled detail and accuracy that significantly enhance clinical decision-making and patient outcomes.
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Introduction: Coma is a medical emergency, and optimal management, especially in a resource-poor setting, depends on knowledge of its aetiology and predictors of outcome. This study aimed to provide hospital-based data on the prevalence, etiology, and outcome of non traumatic coma (NTC) in adults at a tertiary level in Cameroon. Methods: A three year retrospective cohort study of medical records of patients aged 18 years and above, who presented in coma of non-traumatic origin at a Cameroon emergency department (ED) was conducted. Data related to sociodemographic, clinical findings, investigations, etiology of the coma, and outcomes were collected. Results: A total of 408 patients were recruited, 214 (52.5 %) were males. The mean age was 55.9 ± 16.6 years. NTC accounted for 2.2 % of all consultations at the ED during the period of study. Stroke (29.6 %), infections (19.8 %), and metabolic disorders (12.6 %) were the most frequent cause of NTC. Etiology was unknown in 23.3 % of our participants. The in-hospital mortality was 66.4 %. Duration of hospitalization ≤ 3 days, GCS ã 6, serum creatinine level ã 13 mg/L, and administration of adrenergic drugs were predictors of mortality. Overall survival rate was 44.3 % after 5 days of admission. Conclusion: Non-traumatic coma had various aetiologies. Stroke accounted for almost one third of cases. About three out of five patients died in hospital. Deep coma, high serum creatinine level, short hospital stay and administration of adrenergic medications were independent predictors of mortality.
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BACKGROUND: Spinal tuberculosis (STB) is a significant contributor to non-traumatic myelopathy. There is a rising burden in Africa, in parallel with the high prevalence of human immunodeficiency virus. We conducted a scoping review to highlight the disparities in the management and outcomes of STB in Africa. METHODS: This study was conducted using the preferred reporting systems for systematic review and meta-analysis extension for scoping review guidelines. AJOL, Embase, MEDLINE, Google Scholar, and Cochrane CENTRAL databases were searched to identify all relevant peer-reviewed articles published on the management of STB in African centres, excluding abstract-only articles, literature reviews, and meta-analyses. RESULTS: 60 studies were eligible for inclusion, comprising data from 3416 patients aged eight months to 89 years (median, 32 years). Thoracic and lumbar segments were the most commonly affected vertebral regions (Thoracic = 42.7%; Lumbar = 35.9%). The most common clinical features were back pain and neurological deficits. Lack of essential laboratory and imaging diagnostic infrastructure was a common problem. Patients received antitubercular therapy (ATT) for varying durations and only 18.3% underwent surgery. A favourable outcome was achieved in 51.6% of patients, 20.3% developed a permanent disability, and the mortality rate was 2.1%. Treatment outcome was adversely affected by a high rate of late presentation and treatment default. CONCLUSIONS: ATT remains the mainstay of treatment, however, the duration of treatment varied widely among studies. Further research is required to explore the feasibility and efficacy of short-course ATT in treating STB in the African population.
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Patients frequently present to the emergency department (ED) with non-specific complaints such as body aches and generalized weakness, which can have an extensive differential diagnosis. Hypothyroidism and rhabdomyolysis are known causes of generalized weakness and body aches but are usually considered separate entities. In this article, we describe a patient who presented to the ED with symptoms including generalized weakness and muscle aches and was diagnosed with rhabdomyolysis. She presented days later with ongoing, worsening symptoms and was diagnosed with hypothyroid-induced rhabdomyolysis and acute kidney injury. Patients who present with non-specific complaints may have delayed diagnoses that can lead to progression of their disease. Patients with hypothyroidism can develop non-traumatic rhabdomyolysis which can later lead to acute kidney injury. This case illustrates the importance of keeping a wide differential when evaluating patients with generalized complaints and recognizing hypothyroidism as a potential cause of rhabdomyolysis.
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Arachnoid cysts can be intra-cranial or along the spinal cord. Intracranial arachnoid cyst is a very rare finding, trauma being the leading case of it. It is extremely rare for the development of intra-diploic arachnoid cyst without a traumatic history. We present a case of an intra-diploic arachnoid cyst communicating with the greater wing of the sphenoid and in close proximity to the cavernous sinus in a known case of Wilson disease for 22 years. Due to its low incidence, there is a gap in the knowledge and discussion of this cystic lesion, its pathophysiology and management, which are discussed in this case report.
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OBJECTIVE: To assess the prevalence rate of intracranial hemorrhage in newborns and to detect the size of the relative risk for different characteristics of the background of intrauterine development according to the materials of the Republican Prenatal Center. MATERIAL AND METHODS: The study was conducted on the basis of the Republican Prenatal Center of the Azerbaijan Republic. All newborns (996 children) (birth weight - 500 grams or more, gestational age - over 22 completed weeks) have been examined by a neuropathologist. If there were signs of any neurological abnormalities, an ultrasound examination of the brain was performed. RESULTS: The prevalence rate of intracranial non-traumatic hemorrhage (INTH) among newborns was 15.66% (4.8% among full-term, 48.8% among premature). Depending on mother's age the prevalence rate of INTH changed from 12.7% (mother's age 20-24 years) to 23.0% (mother's age 35 years or more). CONCLUSION: The risk of INTH statistically significantly increased with maternal age 35 years or more, with 4 or more births, with the birth of a fetus weighing up to 2500 and more than 4000 grams, with a gestational age of less than 37 weeks, with multiple pregnancies and with vaginal delivery.
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Edad Materna , Humanos , Recién Nacido , Femenino , Prevalencia , Factores de Riesgo , Embarazo , Masculino , Adulto , Hemorragias Intracraneales/epidemiología , Hemorragias Intracraneales/diagnóstico por imagen , Edad Gestacional , Azerbaiyán/epidemiología , Adulto Joven , Peso al NacerRESUMEN
Background: Estimated pulse wave velocity (ePWV), which measures vascular aging, is an independent predictor of cardiovascular death. Nevertheless, the relationship between ePWV and all-cause mortality among patients suffering from non-traumatic subarachnoid hemorrhages (NSAH) remains obscure. Consequently, the objective of this study is to ascertain whether ePWV exerts influence on the prognosis of individuals afflicted with NSAH. Methods: Through the Medical Information Mart for Intensive Care IV (MIMIC-IV) database, 644 eligible participants were included. The Kaplan-Meier survival curve method was employed to assess the disparity in survival status between the low and high ePWV cohorts. The Cox proportional hazard model was employed to investigate the association between ePWV and inpatient mortality among critically ill patients diagnosed with NSAH. The Restricted Cubic Spline (RCS) model was employed to examine the dose-response correlation. Subsequently, multivariate Cox regression analysis was performed to identify independent prognostic factors. Lastly, the impact of ePWV on inpatient mortality across various subgroups was evaluated through stratified analysis. Results: Participants were categorized into two groups, delineated by their ePWV levels: a low ePWV level group and a high ePWV level group. Survival analysis unveiled that individuals with high ePWV exhibited a diminished survival rate compared to their counterparts with low ePWV. Following adjustment, low ePWV was significantly linked with a reduced risk of inpatient mortality among patients with NSAH (HR = 0.54, 95% CI = 0.32-0.89, p = 0.016). Simultaneously, analysis employing the RCS model further substantiated a linear escalation in the risk of inpatient mortality with increasing ePWV values. Conclusion: Elevated ePWV levels have been identified as an independent risk factor for the rise in inpatient mortality among NSAH patients and as a significant predictor of the clinical outcome of NSAH.
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Determine the etiologies of non-traumatic extremity compartment syndrome (NTECS), understand the demographics of NTECS patients, describe their diagnostic workup and treatment, and establish their rate and cause of in-hospital mortality. This is a retrospective cohort study of all patients diagnosed with NTECS at two level 1 trauma centers between January 2006 and December 2019. Data pertaining to the etiology of NTECS, patient demographics, diagnostic and treatment modalities, and in-hospital mortality were collected from electronic medical records. A total of 572 patients were included in this study with an average age of 54±18 years. The etiologies of NTECS were categorized into one of seven groups: 233 hypercoagulable state, 113 found-down secondary to substance use, 68 hypocoaguable state, 58 perioperative positioning, 55 shock, 30 infection, and 15 intravenous/intraosseous (IV/IO) infiltration. Approximately 13 % of patients underwent a skin graft or flap procedures, while 13 % of patients required an extremity amputation. The in-hospital mortality was highest in patients who developed NTECS due to shock (58 %). The average in hospital-mortality for all NTECS etiologies was 20 %. While uncommon, many etiologies of NTECS exist and often manifest insidiously. 13% of patients who develop NTECS will require a skin graft / flap, or extremity amputation. 20 % of patients who develop NTECS die during their hospitalization. High clinical suspicion and future research in this field are necessary to improve clinical outcomes for these patients. Level IV: Retrospective review.
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OBJECTIVE: This study compared the survival outcomes of non-traumatic intracerebral hemorrhage (ICH) patients with different famotidine administration routes and explored related risk factors. METHODS: Data from ICH patients between 2008-2019 were extracted from the MIMIC-IV database. Survival differences between patients with intravenous (IV) and non-intravenous (Non-IV) famotidine administration were analyzed using Cox analysis and Kaplan-Meier survival curves. RESULTS: The study included 351 patients, with 109 in the IV group and 84 in the Non-IV group after PSM. Cox analysis revealed that survival was significantly associated with age (HR = 1.031, 95%CI:1.011-1.050, p = 0.002), chloride ions (HR = 1.061, 95%CI:1.027-1.096, p < 0.001), BUN (HR = 1.034, 95%CI:1.007-1.062, p = 0.012), ICP (HR = 1.059, 95%CI:1.027-1.092, p < 0.001), RDW (HR = 1.156, 95%CI:1.030-1.299, p = 0.014), mechanical ventilation (HR = 2.526, 95%CI:1.341-4.760, p = 0.004), antibiotic use (HR = 0.331, 95%CI:0.144-0.759, p = 0.009), and Non-IV route (HR = 0.518, 95%CI:0.283-0.948, p = 0.033). Kaplan-Meier curves showed a significantly higher 30-day survival rate in the Non-IV group (p = 0.011), particularly in patients with normal ICP (HR = 0.518, 95%CI:0.283-0.948, p = 0.033). CONCLUSION: Non-IV famotidine administration significantly improves 30-day survival of ICH patients, especially for those with normal ICP, compared to IV administration.
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Pulmonary embolism (PE) is a life-threatening disease with variable clinical signs and symptoms, and the diagnosis often requires a high index of suspicion. Patients can have a variety of risk factors that predispose them to venous thromboembolic (VTE) disease. This is a case of a female who presented to the emergency room with new-onset fatigue and shortness of breath for five days. The patient was diagnosed with a sub-massive PE with high-risk features. The patient was also hyperglycemic and diagnosed with new-onset diabetes mellitus. For the PE, she was treated with systemic thrombolysis followed by a standard oral factor Xa inhibitor; for her new onset of diabetes, the patient was started on glargine and lispro insulin. This case underscores the importance of comprehensive management for patients with PE and concurrent metabolic conditions.
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Subdural hematoma (SDH) is a disease commonly seen in both the emergency department and the intensive care unit. Here, we present a case of a woman who developed acute SDH, without any precipitating trauma nor predisposing risk factors. She was managed with hemicraniectomy and SDH evacuation, with subsequent cranioplasty. Routine surveillance imaging found a subsequent, small, and again idiopathic SDH. Comprehensive hematologic workup demonstrated no evidence of coagulopathy. To our knowledge, there are minimal prior case reports published in the literature regarding idiopathic, unprovoked SDH.
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STUDY DESIGN: We conducted a retrospective, descriptive register study. OBJECTIVE: The aim of the study was to present the epidemiological and demographic characteristics of the Swedish spinal cord injury (SCI) population. SETTING: Rehabilitation units in Sweden were connected to the National Quality Register for Rehabilitation Medicine (Svenskt Register för Rehabiliteringsmedicin: SveReh). The registry includes data from 26 units around the country. METHODS: Information was extracted from SveReh for patients who underwent rehabilitation for a new onset SCI between January 1, 2016, and December 31, 2020. Data regarding gender, age, aetiology, level of injury, neurogenic bowel and/or bladder dysfunction, complications during the primary rehabilitation, and the need for bi-level positive airway pressure, continuous positive airway pressure, or ventilator were analysed. RESULTS: Mean age at onset was 56 years, and men were overrepresented (66%). Tetraplegia was more common among traumatic SCI (TSCI) than non-traumatic SCI (NTSCI). The incidence was 11.9-14.8 per million for TSCI and 8.9-11.8 per million for NTSCI. At discharge, 8% of patients needed a breathing aid. Of those who were ventilator-dependent at discharge, 75% had a TSCI. Disturbed bowel and bladder functioning was noted in 58% of patients at discharge. The median time spent at the unit was 40 days, but it was approximately 2 weeks longer for those with a TSCI. CONCLUSIONS: Systematic and updated data on the Swedish SCI population show a pattern similar to Scandinavian countries with high age at onset and falls being the main cause of TSCI. The TSCI incidence was lower than in previous studies, and the results for NTSCI were novel.
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BACKGROUND: Evaluations of critical bleeding and massive transfusion have focused on traumatic hemorrhage. However, most critical bleeding in hospitalized patients occurs outside trauma. The purpose of this study was to provide an in-depth description examining the critical administration threshold (CAT; ≥3 units red blood cells (RBCs) in a 1-h period) occurrences in nontraumatic hemorrhage. This will assist in establishing the framework for future investigations in nontraumatic hemorrhage. METHODS: This is an observational cohort study of adults experiencing critical bleeding defined as being CAT+ during hospitalization from 2016 to 2021 at a single academic institution. A CAT episode started with administration of the first qualifying RBC unit and ended at the time of completion of the last allogeneic unit prior to a ≥4-h gap without subsequent transfusion. The primary goal was to describe demographic, clinical and transfusion characteristics of participants with nontraumatic critical bleeding. RESULTS: 2433 patients suffered critical bleeding, most often occurring in the operating room (71.1%) followed by the intensive care unit (20.8%). 57% occurred on the initial day of hospitalization, with a median duration of 138 (36, 303) minutes. The median number of RBCs transfused during the episode was 5 (4, 8), with median total allogeneic units of 9 (4, 9). Hospital mortality was 19.2%. The most common cause of death was multi-organ failure (50.3%), however death within 24 h was due to exsanguination (72.7%). DISCUSSION: The critical administration threshold may be employed to identify critical bleeding in non-trauma settings of life-threatening hemorrhage, with a mortality rate of approximately 20%.
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CONTEXT/OBJECTIVE: Community integration (CI) is a crucial rehabilitation goal after spinal cord injury (SCI). There is a pressing need to enhance our understanding of the factors associated with CI for individuals with traumatic or non-traumatic etiologies, with the latter being notably understudied. Accordingly, our research explores the associations and potential mediators influencing CI across these populations. SETTING: Specialized neurological rehabilitation center. PARTICIPANTS: Community-dwelling individuals who were admitted as inpatients within 3 months post-injury (n = 431, 51.9% traumatic, 48.1% non-traumatic), assessed in relation to community integration within 1-3 years after discharge. OUTCOME MEASURE: Community Integration Questionnaire (CIQ). Covariates: American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM) and Hospital Anxiety and Depression Scale (HADS). RESULTS: Multiple linear regression yielded age, B AIS grade, educational level (< 6 years and <12 years), time since injury to admission, length of stay, HADS-depression at discharge, total FIM at discharge and three social work interventions (support in financial, legal and transportation services) as significant predictors of total CIQ score (Adjusted R2 = 41.4). Multiple logistic regression identified age, traumatic etiology, educational level (< 6 years and <12 years), length of stay, HADS depression at discharge, total FIM at discharge and one social work intervention (transportation support) as significant predictors of good community integration, AUC (95% CI): 0.82 (0.75-0.89), Sensitivity:0.76, Specificity:0.73. We identified motor FIM at discharge and motor FIM efficiency as causal mediators of total CIQ. CONCLUSIONS: We identified modifiable factors during rehabilitation-functional independence, depression, and social work interventions-that are associated with CI.
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PURPOSE: This study aims to identify independent risk factors for preoperative lower extremity deep venous thrombosis (DVT) in patients with non-traumatic osteonecrosis of the femoral head (NONFH), and to develop a prediction nomogram. METHODS: Retrospective analysis of prospectively collected data on patients presenting with non-traumatic osteonecrosis of the femoral head between October 2014 and April 2019 was conducted. Duplex ultrasonography (DUS) was routinely used to screen for preoperative DVT of bilateral lower extremities. Data on demographics, chronic comorbidities, preoperative characteristics, and laboratory biomarkers were collected. Univariate analyses and multivariate logistic regression analyses were used to identify the independent risk factors associated with DVT which were combined and transformed into a nomogram model. RESULT: Among 2824 eligible patients included, 35 (1.24%) had preoperative DVT, including 15 cases of proximal thrombosis, and 20 cases of distal thrombosis. Six independent risk factors were identified to be associated with DVT, including Sodium ≤ 137 mmol/L (OR = 2.116, 95% confidence interval [CI]: 1.036-4.322; P = 0.040), AGE ≥ 49 years (OR = 7.598, 95%CI: 1.763-32.735; P = 0.008), D-Dimer > 0.18 mg/L (OR = 2.351, 95%CI: 1.070-5.163; P = 0.033), AT III ≤ 91.5% (OR = 2.796, 95%CI: 1.387-5.634; P = 0.006), PLT ≥ 220.4*109 /L (OR = 7.408, 95%CI: 3.434-15.981; P = 0.001) and ALB < 39 g/L (OR = 3.607, 95%CI: 1.084-12.696; P = 0.042). For the nomogram model, AUC was 0.845 (95%CI: 0.785-0.906), and C-index was 0.847 with the corrected value of 0.829 after 1000 bootstrapping validations. Moreover, the calibration curve and DCA exhibited the tool's good prediction consistency and clinical practicability. CONCLUSION: These epidemiologic data and the nomogram may be conducive to the individualized assessment, risk stratification, and development of targeted prevention programs for preoperative DVT in patients with NONFH.
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Necrosis de la Cabeza Femoral , Nomogramas , Trombosis de la Vena , Humanos , Trombosis de la Vena/epidemiología , Trombosis de la Vena/etiología , Trombosis de la Vena/diagnóstico por imagen , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Necrosis de la Cabeza Femoral/epidemiología , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Anciano , Periodo Preoperatorio , Ultrasonografía Doppler Dúplex , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Medición de RiesgoRESUMEN
CONTEXT: Girls' high school volleyball is a popular sport with a high rate of overuse injuries and sport specialization. Health professionals perceive that high school athletes are reluctant to follow treatment plans involving sport activity reduction. This study's purpose was to describe high school girls' volleyball athletes' self-reported shoulder and knee pain, the likelihood of adhering to medical advice, and the association of factors that influence the likelihood of reporting overuse injuries and sport specialization. STUDY DESIGN: Cross-sectional. METHODS: Participants completed an online survey (demographics, sport participation measures, shoulder and knee pain information, medical adherence likelihood [4-point Likert: not at all likely to extremely likely], and factors influencing overuse injury reporting intentions). A 2 × 2 chi-square analysis compared factors that influence athletes' intentions to "not report an overuse injury" (eg, I thought my coach would get mad; yes/no) and sport specialization (nonhighly specialized/highly specialized athletes). RESULTS: There were 150 participants (highly specialized = 56%, grade: ninth = 33%, 10th = 28%, 11th = 22%, 12th = 17%). At least 60% reported shoulder and knee pain related to an overuse mechanism. Most reportedly did not seek rehabilitation led by a medical provider (shoulder pain = 66%, knee pain = 60%). Only 11% of athletes reported they were "extremely likely" to rest from sporting activity during the regular season if advised by a medical professional. Highly specialized athletes were more likely to report the pursuit of a college scholarship as a factor that influences their intention to report an overuse injury compared to nonhighly specialized athletes (13% vs 3%, respectively, P = .04). CONCLUSIONS: Most girls' volleyball athletes did not treat their pain with guided rehabilitation, which may increase their risk of a worse overuse injury or even acute injury. Clinicians, athletes, parents, and coaches need to work together to create a sport culture that empowers athletes to discuss their pain and overuse injuries with medical professionals.
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Trastornos de Traumas Acumulados , Intención , Autoinforme , Voleibol , Humanos , Voleibol/lesiones , Femenino , Trastornos de Traumas Acumulados/rehabilitación , Adolescente , Estudios Transversales , Traumatismos en Atletas/rehabilitación , Traumatismos en Atletas/psicología , Atletas/psicología , Traumatismos de la Rodilla/rehabilitación , Dolor de Hombro/rehabilitación , Manejo del Dolor , Encuestas y Cuestionarios , Cooperación del PacienteRESUMEN
Complex regional pain syndrome (CRPS) is an uncommon neuropathic pain illness characterized by extreme discomfort, muscular weakness, limb edema, and hyperhidrosis. Fracture, surgery, stroke, and spinal cord damage are all potential risk factors. This case report study provides a detailed description of no-traumatic CRPS, a complex pain illness characterized by sensory, vasomotor, sudomotor, motor, trophic, and edematous changes and persistent discomfort. We reported a case of a 39-year-old male with a seven-year history of severe right shoulder-hand pain. He presented with recurrent hand and shoulder pain characterized by burning sensations and weakness, despite not having experienced this before, and he denied any history of trauma or fracture. Surgical procedure and pharmaceutical therapy were provided, but there was no outcome, as evidenced by the patient's clinical condition and the medical records. Despite extensive investigation, no imaging or laboratory tests have been developed for diagnosis, necessitating further research for a comprehensive understanding and diagnosis.
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BACKGROUND: Pediatric spontaneous intracranial dissecting aneurysms are rare, but systematic studies comparing hemorrhagic and ischemic presentations are lacking. This study addresses gaps in understanding their epidemiology, clinical presentation, management, and outcome. METHODS: A retrospective analysis of 23 pediatric patients with nontraumatic intracranial dissecting aneurysms treated between July 2018 and December 2023 was conducted. Patients were divided into 2 groups based on presentation: hemorrhagic (n = 16) and ischemic (n = 7). Clinical data were analyzed, including demographics, radiologic findings, treatment modalities, and outcomes. RESULTS: Clinical presentations varied, with limb weakness being more prevalent in hemorrhagic cases (P = 0.014), while headache and seizures were more common in ischemic cases. Angiographic analysis revealed distinct patterns, with hemorrhagic cases showing more distal involvement on vessel segments with stenosis and dilatation (pearl string sign). At the same time, the ischemic group exhibited the double-lumen sign. Various treatments, including microsurgery and endovascular techniques, were utilized, with perioperative complications observed, including one mortality in a hemorrhagic case. Multiple regression analysis identified significant risk factors for perioperative complications, namely, the configuration of the dissecting aneurysm (P = 0.016) and the type of presentation (P = 0.0006). Long-term Glasgow Outcome Scores were comparable, but patients with hemorrhagic manifestations experienced prolonged hospital and ICU stays (P = 0.001). CONCLUSIONS: Pediatric intracranial dissecting aneurysms, particularly hemorrhagic cases, are associated with severe neurologic deficits and higher perioperative complications. Despite similar long-term outcomes, hemorrhagic cases require prolonged hospitalization, increasing treatment costs. Optimizing management strategies for pediatric intracranial dissecting aneurysms, especially those with hemorrhagic features, is essential to improve outcomes and reduce healthcare expenditures.