A rare patient who had rapid spontaneous resolution of an acute subdural hematoma caused by boxing is reported. On admission a CT scan showed a subdural hematoma containing a low-density area over the left cerebral hemisphere. The subdural hematoma had disappeared on a CT scan taken 1 day after the injury. But magnetic resonance imaging showed that the subdural hematoma was not completely resolved. The hematoma was detected diffusely covering the cerebral convexities and the left side of the tentorium. The outcome was good with nonsurgical treatment. We present this case and discuss the mechanisms of rapid resolution of acute subdural hematoma.
A case of head injury with rhabdomyolysis during thiamylal therapy is reported. The total dose of thiamylal was 489mg/kg, which was higher than that in the usual barbiturate therapy. The blood concentration of thiamylal seemed to be more than 10mg/dl on the CPK max-day, and without plasma exchange, CPK and s-Mb were decreased within 24 hours after stoppage of the thiamylal treatment. This suggests that the cause of this rhabdomyolysis was not pressure necrosis, arterial occlusion nor infection, but thiamylal intoxication. The mechanism of this rhabdomyolysis seemed to involve an abnormality of cell membrane function induced by thiamylal intoxication.
We report a case of Aeromonas hydrohila septicemia in a previously healthy and non-immunocompromised patient without any trauma. The onset was sudden with symptoms resembling acute deep vein thrombosis. Shortly, the patient suffered progressive myonecrosis and gas gangrene with rapid fatal outcome. A 55-year-old man noticed left elbow pain 12 hours prior to admission. The left upper extremity was diffusely swollen with several hemorrhagic bullae on the dorsum of the hand and forearm. Angiographic findings revealed no obstructive changes in the vein. Despite the intensive therapy, his general condition progressively worsened, and gas production with a foul odor began. With the diagnosis of gas gangrene, disarticulation of the left upper extremity was performed. Postoperatively, the patient became hypotensive without response to intravenous fluid and cathecholamines and he died 24 hours after admission. Aeromonas hydrophila was identified from samples of arm muscle and blood obtained at the operation.
Early diagnosis of phlebothrombosis of the superior mesenteric vein is difficult, and in most cases this condition must be treated by enterectomy. The patient, a 56-year-old male with no past history of phlebothrombosis, was brought to the hospital with a chief complaint of abdominal pain. Angiography led to a diagnosis of phlebothrombosis of the superior mesenteric vein, and fibrinolytic agents were therefore administered via a catheter placed in the superior mesenteric artery. Following partial enterectomy on the 10th day, a catheter was inserted into the superior mesenteric vein. Continuous fibrinolytic therapy was effective in preventing postoperative recurrence; dissolution of the phlebothrombosis in the portal vein was also observed.
A rare case of brain stem infarction as a complication of cervical spine injury is reported. A 15-year-old male had sustained a cervical spine injury complicated by quadriplegia. Cervical X-ray and CT scan revealed a right facet dislocation at C4/5. Ten hours after open reduction of the dislocation, he developed cranial nerve deficits. Vertebral angiograms showed complete occlusion of the basilar artery at its origin and of the right vertebral artery. Brain MRI demonstrated infarction of the medulla and pons. The fact that a follow-up angiogram revealed intimal injury of the right vertebral artery suggested embolization of the basilar artery originating at the initial site of injury of the vertebral artery. Vertebral artery injury may be a common lesion following cervical trauma. Consequently, the possibility of secondary infarction of the brain stem or cerebellum should be taken into consideration in managing patiens with cervical spine injuries.
Two cases of severe gastrointestinal hemorrhage caused by cytomegalovirus (CMV) infection are reported. Case 1: The patient had massive hematochezia caused by a CMV infection of the stomach and ileocecal region during steroid therapy for the treatment of interstitial cystitis. Surgery and the intra-arterial pitressin stopped the hemorrhage, but the patient subsequently died due to multiple organ failure. Case 2: While undergoing postoperative chemotherapy for a tumor of the testis, the patient developed Candida sepsis as a result of agranulocytosis, whereupon massive diarrhea and hematochezia occurred because of a CMV infection of the duodenum. Surgery, however, stopped the hemorrhaging, and the patient recovered favorably and was released from the hospital. CMV is liable to cause increased pathological changes in the gastrointestinal tract, and this should be anticipated even by those in the field of emergency and critical care medicine. Hence, it is necessary to be knowledgeable about CMV infections so that a precise diagnosis can be made.