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Teaching NeuroImages: Myeloperoxidase-anti-neutrophil cytoplasmic antibody-positive hypertrophic pachymeningitis

A 49-year-old woman with chronic epistaxis presented with painless left monocular vision loss. Notable findings on examination of the left eye included visual acuity of 20/200 and relative afferent pupillary defect. MRI of the brain revealed enhancement of the left optic nerve sheath and diffuse dural thickening (figure). Laboratory workup yielded only lymphocytic pleocytosis (12 white blood cells) and positive serologies for perinuclear anti-neutrophil cytoplasmic antibodies (ANCA) and anti-myeloperoxidase (MPO) antibodies. Dural biopsy showed multifocal dense lymphoplasmacytic infiltration with vasculitis and reactive fibroplasia. A diagnosis of MPO-ANCA-positive hypertrophic pachymeningitis was made. This phenotypic variant of granulomatosis with polyangiitis is typically restricted to the CNS and upper airway; treatment involves immunosuppression.1 The patient improved clinically and radiographically with prednisone and rituximab.
Source: Neurology - Category: Neurology Authors: Tags: MRI, All Immunology, Vasculitis, All Neuro-ophthalmology, Optic nerve RESIDENT AND FELLOW SECTION Source Type: research

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Robotic-assisted knee arthroplasty has been clinically available for the past 2 decades, but is still in the early stages of adoption for use in total knee arthroplasty (TKA). The purpose of this technology is to improve the precision, accuracy, and reproducibility of TKA. Robotic-assisted systems may be passive, semiactive, or active. Although robotic-assisted systems have been used extensively in unicondylar knee arthroplasty, there are relatively few studies of using this technology in TKA. These early studies have shown that robot-assisted technology may lead to improvements in both mechanical axis and component alignm...
Source: Techniques in Orthopaedics - Category: Orthopaedics Tags: Symposium Source Type: research
This article describes a new percutaneous method of thoracolumbar fracture reduction based on the 6-screw construct, which promotes an indirect reduction of the fractured vertebrae with lordotic rods connected with 4 long monoaxial percutaneous pedicle screws in the fractured and upper adjacent vertebrae. The vertebra below the fractured one is instrumented with polyaxial screws to facilitate the introduction of the lordotic rods. The postoperative radiography and computed tomography imaging results show that this technique is able to correct posttraumatic kyphosis and provide a solid and durable construct.
Source: Techniques in Orthopaedics - Category: Orthopaedics Tags: Special Technical Article Source Type: research
Source: BMJ News - Category: General Medicine Source Type: research
Authors: Aoki Y, Kitazawa K, Kobayashi H Abstract Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is rare in children and is characterised as necrotising vasculitis predominantly affecting small and medium-sized vessels. Propylthiouracil (PTU), an antithyroid drug, has been implicated in drug-induced AAV. In contrast, Kawasaki disease (KD) is a common systemic vasculitis, typically observed in children, which affects the medium-sized vessels, including the coronary arteries. An 11-year-old girl who developed AAV while receiving PTU therapy for Graves' disease is described. She was admitted t...
Source: Paediatrics and international child health - Category: Pediatrics Tags: Paediatr Int Child Health Source Type: research
CONCLUSION: PED provide a safe and effective methord for the treatment of intracranial complex aneurysms like wide-neck aneurysms, fusiform aneurysms, giant aneurysms in low risk of procedural complications and high rates of aneurysm occlusion. PMID: 29457589 [PubMed - in process]
Source: Bio-Medical Materials and Engineering - Category: Materials Science Authors: Tags: Biomed Mater Eng Source Type: research
The objective of this study was to explore the efficacy of a chemical device containing zinc and octenidine in the treatment of chronic periodontitis in adult patients. Ten patients with a diagnosis of chronic periodontitis (20 localized chronic periodontitis sites) in the age group of 35 to 55 were selected. None of these patients received any surgical or non-surgical periodontal therapy and demonstrated radiographic evidence of moderate bone loss. The chemical device zinc plus octenedine was used by each patient after daily oral hygiene. Microbial analysis were analyzed at baseline and on the 15th day. After the treatmen...
Source: Journal of Biological Regulators and Homeostatic Agents - Category: Biomedical Science Tags: J Biol Regul Homeost Agents Source Type: research
We present a new surgical technique for the treatment of depressed intra-articular pisiform fractures. First, the depressed fragment was reduced by pushing the bone tamp. Then, the fracture void resulting from the reduction of the depressed fragment was filled with a shaped hydroxyapatite block. Finally, the fragments were sutured using braided polyblend polyethylene sutures. The postoperative radiography could achieve a well-reduced articular facet, and this procedure had a good clinical outcome.
Source: Techniques in Hand and Upper Extremity Surgery - Category: Surgery Tags: Techniques Source Type: research
Authors: Hadzik-Blaszczyk M, Zdral A, Zielonka TM, Rozy A, Krupa R, Falkowski A, Wardyn KA, Chorostowska-Wynimko J, Zycinska K Abstract Alpha-1 antitrypsin (A1AT) deficiency is one of the most common genetic disorders in Caucasian population. There is a link between granulomatosis with polyangiitis (GPA) and most frequent variants of SERPINA1 gene encoding severe alpha-1 antitripsin deficiency. However, the potential effect of Pi*Z, Pi*S as well as other SERPINA1 variants on clinical course of vasculitis are not well understood. The aim of the study was to analyze the potential effect of A1AT protein phenotype repr...
Source: Advances in Experimental Medicine and Biology - Category: Research Tags: Adv Exp Med Biol Source Type: research
Background: The aim of the study was to determine whether the incidence of radiolucent lines can be reduced and cement penetration enhanced by using jet lavage before cementing the tibial component in total knee arthroplasty (TKA). Methods: We prospectively studied a consecutive series of 86 cemented TKAs. In group A (n=44) jet lavage and in group B (n=42) conventional syringe lavage were used to clean the cancellous bone. A standardized cementing technique was applied in all patients. At a minimum follow-up of 1 yr, patients were evaluated clinically and radiographically. The cement bone interface under the ti...
Source: Current Orthopaedic Practice - Category: Orthopaedics Tags: Original Research Source Type: research
Authors: Chen C, Chen K, Huang X, Wang K, Qian S Abstract The current study presents the case of a 9-year-old Chinese boy who presented with eosinophilia and elevated serum levels of immunoglobulin G4 (IgG4). A bone marrow puncture identified an elevated eosinophil rate of 23% (normal range,
Source: Experimental and Therapeutic Medicine - Category: General Medicine Tags: Exp Ther Med Source Type: research
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