Silvayu8655

We recently started India's first proton beam therapy facility. Proton beam therapy because of its unique physical characteristics of minimal exit dose has an unequivocal dosimetric superiority over high-end photon/standard X-ray beam therapy and is particularly advantageous in growing children with curable cancers in view of their very high probability of long-term cures. We hereby report a case of a 7-year-old boy with a craniopharyngioma which had been subtotally resected and was subsequently treated with modern pencil beam proton therapy under high-precision image guidance. This is the first ever child ever to be treated with proton therapy in India.Acute aortic dissection (AAD) complicated with acute cerebral infarction lacks a unified treatment plan. We report probably the most effective treatment of a type A AAD with acute cerebral infarction leading to coma. A 43-year-old man presented with acute hemiplegia and unconsciousness. He was diagnosed as acute cerebral infarction. After an ineffective emergency intravenous thrombolysis, a Digital Subtraction Angiography (DSA) examination revealed the severe cerebral artery occlusion, and the TICI 3 level was achieved by stent implantation in the left common carotid artery with significant neurological recovery. A type A AAD was found at the 1 month follow-up ultrasound examination and a further thoracic surgery was performed successfully. Carotid ultrasound is helpful for the diagnosis of AAD from acute cerebral infarction. Filanesib ic50 Carotid artery stenting followed by thoracic surgery is effective in this kind of emergency situations. Further studies are needed to determine the exact indications.A 34-year-old man presents with recurrent episodes of acute reversible muscle weakness, soreness, pain, cramps and myoglobinuria with elevated creatine kinase. Symptoms were triggered by fasting, sustained long duration exercise and viral infection. A metabolic myopathy was suspected. Genetic testing showed a homozygous pathogenic variant in CPT2 gene resulting in deficiency of Carnitine Pamitoyl transferase II, an enzyme in the carnitine cycle. The cycle plays a vital role in transport of long chain hydrophobic fatty acids from the cytosol into the mitochondrial matrix for the production of energy via β-oxidation. Carnitine Pamitoyl transferase II deficiency is the most common inherited disorder of lipid metabolism affecting the skeletal muscle of adults. It is also the most frequent cause of hereditary myoglobinuria across all ages. Our case presents an analysis of important clinical features of carbohydrate and lipid metabolism disorders. It highlights how thermolability of the mutant enzyme, rather than its actual deficiency, explains triggering of muscle symptoms by prolonged exercise, infections, febrile episodes, or exposure to cold.Sheehan syndrome, characterized by postpartum pituitary necrosis, is an important cause of hypopituitarism in developing countries. We report the case of a 50-year-old female with Sheehan syndrome, who had two spontaneous conceptions following severe postpartum hemorrhage in her first delivery and presented 27 years later with moderate pericardial effusion and features of pseudohypertrophic myopathy mimicking muscular dystrophy.Understanding the pathogenesis and the typical imaging features of carotid artery web, and accurately diagnosing the carotid artery web will help to implement targeted intervention for cryptogenic stroke and reduce the recurrence of stroke events. Carotid web (CW) can be defined as an endoluminal shelf-like projection often noted at the origin of the internal carotid artery just beyond the bifurcation. It is recognized as a possible cause of ischemic stroke in young adults. We describe here a case of ischemic stroke caused by a CW in a healthy man. Detection of this vascular abnormality required the use of computed tomography angiography. CW is a specific anatomical structure. Its imaging and clinical manifestations are different from atherosclerosis. It's also is a latent etiology to cryptogenic stroke. CW should be considered in patients with otherwise cryptogenic stroke, otherwise healthy patients presenting with stroke and without the typical risk factors for atherosclerotic carotid disease and stroke.Basilar artery dissections are rare events which present with subarachnoid hemorrhage (SAH), brain ischemia, and usually have a fatal outcome. Few case reports of mycotic dissections are published in literature. We report a case of a young male who underwent surgical treatment for post-traumatic CSF rhinorrhea. He presented 3 years later with signs of bacterial meningitis. During medical management with antibiotic therapy, he developed basilar artery aneurysm in a span of 2 days, had subarachnoid hemorrhage and deteriorated. CSF culture grew alpha hemolytic streptococci. Despite medical management, he developed brain stem infarcts and succumbed. This report highlights a rare fatal complication of mycotic dissecting aneurysm of the basilar artery following meningitis, which developed acutely in hospital, while on treatment. Antibiotic therapy had not altered the course of disease. It is advisable to investigate for presence of ruptured mycotic aneurysms or dissection in cases of bacterial meningitis leading to SAH.Standard treatment of drug-refractory epilepsy, due to left mesial temporal sclerosis, is anterior temporal lobectomy with amygdalohippocampectomy (ATL). This carries a risk of cognitive deficits, including comprehension, verbal memory, and visual memory. Preoperative language lateralization and localization is important to preserve these functions. Often Wada testing is used for these, but it carries risk due to its invasive nature. In addition, it can lateralize but not localize and may not be readily available. We hereby present a mathematics genius who underwent left ATL under the guidance of functional MRI and neuropsychological assessment alone, resulting in the preservation of all of his cognitive abilities even in the immediate postoperative period. A video demonstration of his calendar likeability is also shown.A 40-day-old female child presented to us with an oral cavity mass, noticed at birth and progressively increasing in size. Preoperative computed tomography revealed intracranial extension of the lesion. Airway management, securing and maintaining invasive vascular access peri-operatively and transport of the patient to MRI suite were the major challenges. Mask ventilation was difficult and successful intubation required three attempts. Otorhinolaryngologists were present in the theatre during induction to perform a tracheostomy if the situation so demanded.