Asian Australasian Neuro and Health Science Journal (AANHS-J)

Surgical Procedure for a Rare Case of Skull Bone Cysts

Ahmad Rafiqi — 2023-12-20

Introduction:

Bone cysts are inclusive of but not limited to the unicameral bone cyst (UBC) and aneurysmal bone cyst (ABC). UBC have a predilection for males (3:1). UBC make up 3% of primary bone lesions. Most UBCs are found in long bones, most common sites are proximal humerus and femurs, rarely found in flat bones (Skull). Cases of UBC observed following trauma are thought to occur due to intraosseous bleeding when bone organization or repair mechanisms fail.

Case Report:

Twenty-one-year-old male complained of headache, a history of traumatic brain injury. Motoric examinations show diminished motor function on the left side. CT Scan shows an expansile sclerotic lytic lesion on the right parietal bone. We diagnosed this case with a suggested Bone Cyst on the right parietal, and craniotomy tumor removal with a direct approach was performed. Thickened dura mater was identified, cleansed using NaCL and povidone-iodine, and drilled using a high-speed drill until flattened. The yellowish-colored bony lesion was discovered to contain a semi-translucent substance, the lesion was found to be a unicameral bone cyst.

Discussion:

UBCs are generally asymptomatic, and usually appear as lesions with lucent characteristics and small zones of transition. As a benign bone tumor, treatments are not required unless the lesion is large and symptomatic, due to the patient's symptomatic condition, craniotomy tumor removal was performed.

Conclusion:
UBC is a rare condition, that’s scarcely located in the skull. Post-operatively, the patient shows normal motor function and no complaint of pain. Craniectomy tumor removal and flattening of the dura mater using a high-speed drill is sufficient in treating this rare disease.

Drug-resistant Tuberculosis in Pediatric

Halisyah Hasyim Lubis — 2023-12-20

Introduction: Drug-resistant tuberculosis (DR TB) is a condition where Mycobacterium tuberculosis is resistant to isoniazid, rifampicin or resistant to isoniazid and rifampin as well as other first-line anti-tuberculosis drugs (OAT). Tuberculosis (TB) is a contagious infectious disease, caused by Mycobacterium tuberculosis germs where the source of transmission is through droplets containing TB germs.

Case Report: A 10 years 7 months girl, came to the MDR Polyclinic at the Haji Adam Malik Medan Central General Hospital (RSUP HAM Medan) on March 21 2023 bringing the results of the TB Molecular Rapid Test (TCM-TB) examination from the Teladan Barat Health Center with Rifampicin results were resistant and on March 24 2023 the patient was hospitalized. Currently, the patient is complaining of a cough that has been experiencing for ± 3 weeks. Cough with the impression of a dry cough and is continuous so that it interferes with daily activities. The cough does not improve even though the patient has taken cough medicine. There is no fever, there is also no history of previous fever. According to the anamnesis from the patient's parents, there has been a weight loss in the last 2 months, around ± 4 kg. There is no family history of long-term cough, but according to parents, there is a neighbor of the patient who suffers from pulmonary TB and is undergoing treatment.

Discussion: After the diagnosis of drug-resistant tuberculosis is confirmed, an evaluation is carried out whether the patient meets the criteria for drug-resistant TB treatment guided by short-term or long-term oral drug-resistant tuberculosis. Patients who meet the evaluation criteria for treatment can immediately be given short-term oral drug-resistant tuberculosis therapy. If the patient does not meet the criteria for short-term treatment, long-term drug-resistant tuberculosis treatment is given. Routine evaluations are carried out during treatment and when the results of drug sensitivity tests are available, treatment is adjusted according to the examination results.

Conclusion: A case of drug-resistant tuberculosis in a girl aged 10 years 7 months has been reported which was diagnosed based on anamnesis, physical examination, and supporting examinations, there was also a history of close contact with TB sufferers, and the results of TCM examination of sputum fluid showed rifampicin resistant MTB growth. Patients are treated as drug-resistant TB cases with a short-term regimen with regular monitoring of treatment response and side effects.

Cervical Tuberculous Spondylitis

2023-12-20

Introduction: Cervical tuberculous spondylitis is a rare disease and low prevalence in all spinal diseases. The cervical region is more vulnerable to volume addition because of tight space in the spinal canal that could damage neurological function.

Case description: A 25-year-old female with pain in the posterior of her neck. The pain was accompanied by numbness and tingling that radiated from the hind neck to the left hand. She had no systemic symptoms. She also had a small-sized lump in her hind neck. The patient admitted that she had undergone an antituberculosis drug regimen three months before. The neurological and physical examination revealed hypesthesia in the left upper limb and gibbus in the hind-neck which was approximately one centimeter in diameter. MRI examination revealed that suspicion of cervical tuberculous spondylitis. The patient had undergone debridement laminectomy and posterior stabilization surgery. The pathology impression revealed that supporting tuberculous chronic specific spondylitis.

Discussion: Progresivity of abscess led to necrosis of the bone and its surrounding tissue that could cause deformities and neurological symptoms.

Conclusion: Cervical tuberculous spondylitis is a very rare case, because it used to be in lumbar or thoracic vertebrae. If this case had been left untreated, it would have a severe prognosis.

Cerebral Abscess In A Child With Unknown Origin Of Infection

Syekh Ahmad Arafat Husain — 2023-12-20

Introduction: The incidence of brain abscesses is higher in developing countries. The classic triad of fever, headache, and focal neurological signs was seen in 9–28% of the pediatric cases. Brain abscesses occur infrequently with potentially life-threatening conditions.

Case Report: The patient was a child 1 year 8 months old with a main complaint of weakness in the left arm and leg progressively for one month. She had a local seizure on her left arm and leg one month before admission with a duration of 30 minutes. She was irritable for the last two weeks. The strength of the upper and lower extremities was 3 respectively. The physiology reflex was hyper-reflex on the upper and lower extremities. A Head non-contrast CT scan showed a hypodense lesion on the right parietal with a perifocal edema lesion. A head contrast CT scan showed a hypodense lesion on the right parietal with ring enhancement measuring approximately 6,2 cm x 4,5 cm. Craniotomy evacuation abscess with near total capsulectomy was done on initial and capsule resection was done.

Discussion: Brain abscess is a focal pyogenic infection of the brain parenchyma, and the frontotemporal lobe is the most common site of brain abscess, followed by frontal-parietal, parietal, occipital lobes, and cerebellar. The most common risk factors that predispose a child to the formation of a brain abscess include congenital heart disease, sinus and otogenic infections, and poor dental hygiene. The triad of brain abscess, including headache, fever, and neurological symptoms is only present in (15%) of the cases reported. Medical treatment is recommended in patients without increased intracranial pressure, with symptoms of less than 1 week long and abscess of less than 2 cm seen in tomography. The suggested time of treatment is between 6 and 8 weeks with intravenously administered antibiotics. A full recovery rate from the infection of about 60–70% is reported in the case of early diagnosis and proper therapy

Conclusion: Cerebral abscess in pediatrics with unknown origin of infection may happen in 12%. Early diagnosis and treatment of pediatric cerebral abscesses can reduce morbidity and mortality rates. A broadspectrum antibiotic is an optimal treatment in the postoperative evacuation of cerebral abscess cases with unknown origin infection.

A Rare Case of Pleural Tuberculosis with Tuberculous Pyomyositis

Perdana Putra Lubis — 2023-12-20

Introduction: Tuberculosis (TB) gained recognition throughout the 19th century as it inflicted significant mortality rates upon a vast number of individuals across the globe. Pleural tuberculosis and tuberculous pyomyositis are infrequently documented extra-pulmonary manifestations, with limited coverage in the medical literature, and their underlying pathophysiological mechanisms remain unclear. There is a scarcity of published evidence about the management of pleural tuberculosis with tuberculous pyomyositis.

Case report: We reported a case of a 51-year-old female patient who presented with progressive exacerbation of dyspnea, elevated body temperature, nocturnal diaphoresis, active cough, and pleuritic chest discomfort localized to the right side for twelve weeks duration. This patient also had multiple bulges in the left lumbal, left upper chest, and axillary regions. Several people living near the patient's home were diagnosed with tuberculosis. During the examination, the patient exhibited decreased breath sounds and a dull percussion note in the right lung field. The chest radiograph revealed a substantial pleural effusion in the right hemithorax. She was subsequently started on four daily anti-tuberculosis therapy and pleural fluid drainage. On the fifth month of follow-up, the patient showed improvement in symptoms and the bulging has reduced in size.

Discussion: Pyomyositis is a suppurative infection of skeletal muscle that typically arises from the dissemination of pathogens through the bloodstream. The infection is commonly observed in tropical regions among persons who have significant underlying comorbidities or are immunocompromised.

Conclusion:

Pleural tuberculosis accompanied by tuberculous pyomyositis is an uncommon manifestation outside of the lungs, nevertheless, it is crucial to maintain vigilance regarding this condition. The timely identification of a disease is crucial for the implementation of appropriate treatment and subsequent resolution