Review


Vestibular neuritis in pediatrics: a mini review

Fargol Farahmandi, Ali Nikkhah, Mohammad Reza Khalilian, Parynaz Parhizgar

School of Medicine Students' Journal, Vol. 3 No. 3 (2021),

Background and aims: Vestibular neuritis (VN) is a clinical feature, portrayed by acute and prolonged vertigo from peripheral source without associated auditory symptoms. the appearance of vestibular disease may also lead to cognitive deficits, including attention deficits. Therefore, the purpose of this mini-review is to describe the clinical characteristics, etiology, prevalence and treatment of vestibular neuritis in children.


Materials and methods: The present study was conducted in January 2021. The study was performed based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) checklist. The comprehensive search was conducted in the literature of the international databases (PubMed, Scopus, and Google Scholar) and national databases including scientific information database (SID), Magiran and iranDoc until January 13, 2021. Search keywords included "vestibular neuritis", "vestibular disorder", "balance disorder", and "pediatrics" or "children" or "adolescent" or "infants". The time limit for publishing articles was from 2010 onwards.


Results: In the initial search, 17 articles were extracted. After reviewing the title and abstract, 6 studies were excluded. In the evaluation and full-text review, 2 articles were excluded due to low quality and lack of access to the full text of another article. Finally, 9 studies were included in the present study.


Conclusion: We conclude that vestibular neuritis should always be considered in pediatric patients presenting with vertigo, and especially with nasopharyngeal viral infection, in addition to other differential diagnoses. Vestibular neuritis is one of the most common diseases in vestibular disorders in children, and different prevalence rates have been reported in studies so it needs further investigation. Once the diagnosis of vestibular neuritis is confirmed, symptomatic treatment should be started for the child.

Original Article


Background and aim: Determine clinical and brain MRI findings in patients with repeated stereotypical TIA.


Materials and Methods: Thirty-six patients with symptoms of repeated stereotypical TIA were performed MRI & MRA.


Result: Twenty patients had infarct that 14 cases had lacunar infarct and 6 cases had large infarct.Of these 20 patients, 12 cases had subcortical infarct and 8 cases had cortical infarct. Also, among 36 patients, 18 cases had artery stenosis. There is a significant relationship between artery stenosis and the presence of infarct.In addition, there was no significant relationship between infarct size and the size of the stenosed arteries.


Conclusion: Most patients with repeated stereotypical TIA have infarct in DWI and they have a thrombotic cause and antiplatelet drug can be used instead of anticoagulants.


 

Pituitary Adenoma: A Pathologic Classification of Tumors

Elena Jamali, Farahnaz Bidari Zerehpoosh, Mahsa Ahadi, Afshin Moradi, Narges Forouzangohar

School of Medicine Students' Journal, Vol. 3 No. 3 (2021),
https://doi.org/10.22037/smsj.v3i3.35342

Background and aim:


The classification of pituitary adenomas now includes an “atypical” variant, which can be defined as MIB-1 proliferative index greater than 3%, excessive p53 immunoreactivity, invasive growth pattern, and the increased mitotic activity. Recent guidelines do not precisely define the cutoff points for elevated mitotic activity. Therefore, this study was designed to obtain reliable cut-off values for the mitotic index.


 


Materials and Methods:


 In this study, the authors reviewed the records belonged to 300 patients including 250 patients with typical pituitary adenoma and 50 patients with atypical pituitary who were referred to Loghman Hakim Hospital between 2011 and 2017. Statistical analyses were performed using Fisher’s exact test and Mann Whitney. Also, Cut-off values were attained using ROC analysis.


Results:


In APAs group, 47.8% and 52.2% of the tumors were microadenomas and macroadenomas, respectively. 91.3% of the patients with APAs had Ki-67 labeling index more than 3%, and the presence of p53 protein was observed in all the patients with APAs. The mean number of mitosis in the TPAs and APAs groups was 0.62 and 2.5, respectively. In addition, our results showed significant threshold values for mitotic index (>2 mitosis within 10 high power fields). Also, there was no significant difference between the size of tumors and type of secretion hormones in the APA and TPA groups (P> 0.05).


Conclusion:


We introduced a new cut-off for the mitosis index (greater than 2) that may help to more reliable diagnosis of atypical adenomas (APA). These findings will convince pathologists to adopt this clinicopathological classification, and those clinicians will consider it as helpful when choosing the appropriate therapeutic strategy.

Case Report


Unilateral Visual loss Due to Methanol Intoxication: A Case Report

Hoorvash Faraji Dana, Lida Shojaei Arani, Kiumars Bahmani

School of Medicine Students' Journal, Vol. 3 No. 3 (2021), , Page 35-36
https://doi.org/10.22037/smsj.v3i3.35810

Methanol is a toxic alcohol which can cause severe bilateral visual impairment. In this study we report a case of unilateral visual loss due to methanol intoxication.


A 45-year-old man referred to toxicology department of Loghman Hakim Hospital complaining of bilateral blurred vision, vomiting, nausea. He was oriented and he had drunk about 500 cc alcohol two days ago, he underwent 4 hours of emergency hemodialysis and we also prescribed erythropoietin, Methylprednisolone, Amp folinic acid, Na/HCO3. then he was referred to ophthalmologist that reported: right eye’s acuity 7/10, left eye’s acuity 3m, RADP positive, left eye’s abducent movement and its color was disturbed and retinal examination was consistent with methanol intoxication.


Visual impairment due to methanol poisoning usually occurs bilaterally, but rare cases of unilateral vision damage have also been reported in two studies which they stated may be due to anatomical or structural variation.

Visual Practice


Multiple scaring cutaneous erosions and hoarseness in a 7- month- old infant

Yeganeh Farsi, Fahimeh Abdollahimajd

School of Medicine Students' Journal, Vol. 3 No. 3 (2021),
https://doi.org/10.22037/smsj.v3i4.36437

A seven-month-old female infant was referred to the dermatology clinic due to several erosive cutaneous lesions. The lesions were crusted and super-infected (impetiginized), widespread on her face, trunk and, extremities. Multiple atrophic and ice-pick scars were also remarkable, especially on her face, which was attributable to previous lesions. The lesions have been appeared since one- month of age, and have been resolved on their own with atrophic scars. Hoarseness was another notable finding in her physical examination and the physical examination was otherwise normal. The hoarseness had existed since her birth. Lipoid proteinosis or Urbach- Weithe syndrome is a rare autosomal recessive disorder due to mutation in extracellular matrix protein 1  (ECM 1) characterized by the deposition of hyaline in cutaneous tissue and mucus membrane of aerodigestive tract (2). Mucocutaneous lesions including palpebral and lingual yellowish nodules, laryngeal complications such as hoarseness and obstruction, and neuro-cognitive disorders including learning difficulties, aggression, loss of fear, memory impairment, and seizures are expected in lipoid proteinosis (3-7).