World Neurosurg
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Case Reports
Diagnosis of a CSF-Venous Fistula Associated with a Venous Malformation using Digital Subtraction and CT Myelography.
Spontaneous cerebrospinal fluid (CSF) leaks can be an intractable cause of orthostatic headaches but have several treatable causes. CSF-venous fistulas are an increasingly recognized cause of rapid CSF leaks. Although CSF-venous fistulas have been previously reported in the literature, their imaging appearance, associated anomalies, and treatment are incompletely understood. We present a case of a CSF-venous fistula draining to adjacent venous malformations with symptoms responding to surgical treatment. This is the first such case to our knowledge showing enhancement of venous malformations on computed tomography myelography. ⋯ CSF-venous fistulas are a relatively uncommon cause of spontaneous CSF leaks. Though difficult to diagnose, they can respond to surgical treatment as seen in this case. In our experience, decubitus digital subtraction myelography combined with computed tomography myelography is instrumental in making the diagnosis and fully characterizing any abnormalities associated with the fistula. This case also supports the suggested association between CSF-venous fistulas and venous malformations, which is worthy of continued study.
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Candida auris is an emerging superbug which was recently discovered and has spread widely across the world. With a steady rise in incidence involving multisystems, this presents a unique challenge to caregivers. ⋯ C. auris appears to be an emerging superbug, which is hospital-acquired. All practitioners must be aware of its existence and presentation. Given the low incidence, high mortality, and no clear guidelines of management so far, formulation of any such strategies is complicated. Further studies and research are needed for this superbug.
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Iatrogenic ureteral injury associated with lumbar spine surgery is an uncommon but devastating complication with associated medicolegal implications. ⋯ Ureteral injury associated with lumbar spine surgery is overreported in developed or developing countries. It should be considered in the differential diagnosis of any patient who presents with symptoms of acute abdomen after lumbar spine surgery, and patients who underwent restorative surgery had a good prognosis.
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The sacral dorsal rami form the posterior sacrococcygeal plexus (PSCP), which has been scantly studied. This study's goal was to clarify the PSCP s detailed anatomy and discuss its clinical relevance. ⋯ To our knowledge, this is the first anatomic study that provides detailed images that indicate 3 potential sites where surrounding structures could entrap the PSCP. Knowledge of its detailed anatomy might help in better understanding low-back pain, targeting pain sources and guide spine surgeons for avoiding injury to these nerves.