Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 52 59 Nandlal Bharwani Orthopaedics, DR.S. N Medical College, Jodhpur. Ravina Yadav Pathology, DR.S. N Medical College, Jodhpur. Hemant Jain Orthopaedics, DR.S. N Medical College, Jodhpur. Mahesh Bhati Orthopaedics, DR.S. N Medical College, Jodhpur. 2022 06 04 2023 02 12 Most common benign tumors in orthopedic outdoor clinics seem to be osteochondroma/exostosis which are around 20-50% of all benign bony lesions. Flat bones like iliac blade, scapula, ribs and clavicle which develop from intra-membranous ossification are rarely involved. A28 year old female from rural area presented to orthopedic outdoor clinic with pain and swelling around the inguinal region on right side for past 18 months and diagnosis was made after incisional biopsy. Iliac blade is a rare site for presentation and the patient had no neurovascular compression or mass effect on surrounding structures. Osteochondromas of flat bones are rarely encountered, therefore, proper diagnosis should be made and other differential diagnoses should be considered during evaluation of mass around the pelvic girdle. https://crcp.tums.ac.ir/index.php/crcp/article/view/694

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 86 87 Guilherme Simões Centro Hospitalar e Universitário Lisboa Central Mahesh Goenka Institute of Gastro-Sciences and Liver, Apollo Gleneagles Hospitals, Kolkata, India 2021 12 10 2022 04 16 Clinical images/multimedia article https://crcp.tums.ac.ir/index.php/crcp/article/view/639

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 50 51 Shahin Akhondzadeh Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran Yalda FarahMand Psychiatric Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2023 11 18 2023 11 18 No Abstract No Abstract No Abstract No Abstract https://crcp.tums.ac.ir/index.php/crcp/article/view/895

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 60 63 Mahendra Singh Department of Orthopaedics, Dr.S.N Medical College, Jodhpur. Nandlal Bharwani Department of Orthopaedics, Dr.S.N Medical College, Jodhpur. Navendu Ranjan Department of Orthopaedics, Dr.S.N Medical College, Jodhpur. Mahesh Bhati Department of Orthopaedics, Dr.S.N Medical College, Jodhpur. 2022 06 23 2023 05 22 Charcot Spine Arthropathy (CSA) is a form of degenerative disease affecting vertebra of lumbar and thoraco-lumbar region. It is commonly seen after injury to the spinal cord or in patients with traumatic paraplegia. It was first described by Kronig in 1884. Case Report- A 35year old male patient presented to our outpatient clinic with complaint of difficulty in changing his position while sitting, lying down, and sitting on a wheel chair. In 2014, he had sustained injury to his spinal cord with bowel and bladder involvement with ASIA-A grade neurology for which long segment fixation was performed from D7-D10 level and the patient was wheel chair bound after surgery. In the present case scenario, the patient was managed conservatively with bed rest, immobilization and medications for pain relief as stated in the existing literature. Conclusion- CSA is a disease of surgical origin commonly seen in patients with spinal cord injury in the past. Although surgery in the form of circumferential arthrodesis is the treatment of choice in most of cases, it is reserved for cases with instability, as it is associated with complications like infections and hardware failure. https://crcp.tums.ac.ir/index.php/crcp/article/view/706

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 64 67 Maassoumeh Akhlaghi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Kiarash Kazemi Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. Soheila Sobhani Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2022 11 20 2023 01 31 Infectious mononucleosis (IM), usually caused by Epstein-Barr virus (EBV), is not rare among populations. Fever, pharyngotonsilitis and lymphadenopathy are its major presentations. Since EBV mainly targets lymphomononuclear cells and the reticuloendothelial system, it might be mistaken with hematological malignancies. The case presented in this article showed a very high similarity to an acute lymphoblastic leukemia, which complicated the diagnostic work-up. The histopathological data and clinical course of IM patients are not usually distinctive; hence, early work-up for EBV-associated IM is suggested. https://crcp.tums.ac.ir/index.php/crcp/article/view/758

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 68 71 Salsabeel Hamad Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Israa Abufara Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Safaa Zagharneh Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Taimaa Abureesh Faculty of Medicine, Palestine Polytechnic University, Hebron, Palestine. Afnan Jobran Faculty of Medicine, Al-Quds University, Jerusalem, Palestine. 2023 08 09 2023 08 16 Metachromatic Leukodystrophy (MLD) is commonly characterized by the accumulation of sulfatide in various organs, including the central nervous system, leading to neurological and mental symptoms. We reported a case of a two-year-old male patient with psychomotor retardation history, developmental delay, poor overall performance and imaging findings compatible with Leukodystrophy are presented. The goal of this case report is to identify clinical presentation and typical MRI features to diagnose MLD, in the absence of an enzyme assay or a gene mutation investigation. https://crcp.tums.ac.ir/index.php/crcp/article/view/857

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 72 77 Pravin Shinde Associate Professor, Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India. Rajiv Karvande Professor, Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India. Vaishnavi Chakravarthy Senior Resident, Department of General Surgery, Seth GSMC and KEM Hospital, Mumbai, India. Aarsh Gajjar Undergraduate Student, Seth GSMC and KEM Hospital, Mumbai, India. 2022 12 14 2023 05 24 Pneumoscrotum is the terminology used to describe the presence of air in the scrotal wall or within the tunica vaginalis. The aetiology of pneumoscrotum is varied, ranging from idiopathic to Fournier’s gangrene or perforated bowel leading to significant morbidity and mortality. This paper reviews the existing literature on pneumoscrotum whilst documenting our experience with the same. Diagnosis is dependent on the patient’s anamnesis, clinical signs and imaging. We are presenting a case series of three such cases and a review of the existing literature on the same. The first case is a patient of a road traffic accident who subsequently presented with diffuse subcutaneous emphysema involving the scrotum. The second case is of Fournier’s gangrene with pneumoscrotum. The third case presented with a spontaneous isolated pneumoscrotum without any cause. Imaging such as Contrast-Enhanced CT and USG may be done to help narrow the differentials https://crcp.tums.ac.ir/index.php/crcp/article/view/770

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 78 81 Maryam Kaeedi Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Hosein Kaeidi School of Medicine, Shahid Beheshti University of Medical Science, Tehran, Iran. Mojtaba Shahbazi Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Sanaz Heydari Havadaragh Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Hamed Amirifard Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. 2022 12 22 2023 03 05 Cystic hydatidosis is a rare zoonotic condition, caused by the larva of the Echinococcus tapeworm.  In this disease brain involvement is a rare condition, accounting for about 2-3% of all cases with hydatid disease. Focal deficits, symptoms of increased intracranial pressure, seizure and mental state changes are most common presentations of CNS cystic echinococcosis. We present a young age woman with resistant headache and transient visual obscurations due to increased intra-cranial pressure which caused by Cerebral venous sinus thrombosis (CVST) arising from Hydatid cyst. To the best of our knowledge, this is the first report of hydatid cyst induced CVST. Our case report highlights the importance of considering CVST as an unavoidable complication of brain’s space occupying lesions and especially infective ones as a differential diagnosis. https://crcp.tums.ac.ir/index.php/crcp/article/view/773

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 82 85 Divya Devanathan Department of Anesthesiology, Mahatma Gandhi Medical College, Sri Balaji Vidyapeeth University, Pondicherry. 2022 12 29 2023 02 25 Breathing circuits are the delivery systems which conduct anaesthetic gases from an anaesthetic machine to the patient. They are designed for either spontaneous respiration or intermittent positive pressure ventilation (IPPV). The Bain co-axial circuit, a modification of Mapleson D system is the most commonly used circuit in outside operating room procedures. It has several advantages over the circle system in that it is light-weight, convenient with adjustable length. Although most problems with the circuit involve disconnections, obstruction problems related to kinks in the gas delivery tube  or foreign body in the elbow have been reported. We would like to report an anaesthetic incident involving desaturation of patient posted for electro convulsive therapy (ECT) due to missing part of the Adjustable Pressure Limiting (APL) valve. https://crcp.tums.ac.ir/index.php/crcp/article/view/777

Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 8 2 2023 11 18 88 90 Ziba Khanmoradi Department of Neurology, Kermanshah University of Medical sciences, Kermanshah, Iran. Kian Zohrabi Department of Orthopedic Surgery, Kermanshah University of Medical sciences, Kermanshah, Iran. Zohreh Abna MS Fellowship, Department of Neurology, Tehran University of Medical Sciences, Tehran, Iran. 2023 06 29 2023 08 19 The accessory nerve is the eleventh cranial nerve that supplies the sternocleidomastoid and trapezius muscles. Injury to the spinal accessory nerve is most commonly caused by medical procedures that involve the head and neck, which causes wasting of the shoulder muscles, winging of the scapula, and weakness of shoulder abduction and external rotation. Here, two cases of spinal accessory neuropathy after injection of trapezius muscle for body building are reported. https://crcp.tums.ac.ir/index.php/crcp/article/view/840