Vanguard Health Management, Inc.

Literature is limited regarding the relationship between cochlear magnetic resonance imaging fluid-attenuated inversion recovery (FLAIR) signal and hearing preservation after resection of vestibular schwannoma (VS). We hypothesize that increased preoperative FLAIR signal is associated with decreased odds of hearing preservation.

Retrospective cohort study.

Single academic tertiary/quaternary care center.

Subjects with histologically confirmed intracanalicular VS (without extension into the cerebellopontine angle).

Microsurgical resection via middle fossa approach.

A review of demographic, clinical, radiographic, and audiometric outcomes were performed. Hearing preservation was defined as American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) class A or B hearing. Binary logistic regression analysis was performed with SPSS version 29.

Twenty-seven subjects met inclusion criteria with median age at time of surgery of 47 (interquartile range [IQR]: 38–54) years; 92.60% were White; 66.67% had AAO-HNS class A, and 33.33% had class B hearing. Postoperatively, at median (IQR) of 11.50 (2.10–38.50) months, 44.40% had class A or B hearing. On logistic regression analysis, a ratio of cochlea-to-brainstem FLAIR signal greater than 0.6 was associated with decreased odds of hearing preservation at 11.50 months—odds ratio, 0.13; 95% confidence interval, 0.02–0.84. Age, sex, surgery duration, tumor volume and linear dimension, fundal cap of cerebrospinal fluid, and extent of resection were not associated with hearing preservation.

Increased cochlear FLAIR signal on preoperative imaging is associated with decreased likelihood of hearing preservation after resection of intracanalicular, sporadic VS via middle fossa approach.

We report a rare case of massive left abdominopelvic hematoma (~16.6 × 13.9 × 14.5 cm) from a 1.3 cm pseudoaneurysm on an aberrant uterine artery from the anterior abdominal aorta, arising between the superior mesenteric artery and inferior mesenteric artery, supplying the lateral uterus in a woman in the postpartum period. The hematoma manifested on postpartum day two with signs of hypovolemia and a painful, throbbing lump in the left lower abdomen. Computed tomography (CT) angiography revealed a large retroperitoneal hematoma and a pseudoaneurysm associated with the anomalous artery, which also showed an aorta of normal caliber and no abdominal aortic aneurysm. Successful hemostasis was achieved using selective endovascular coil embolization with adjunct Gelfoam (Pfizer Inc., New York, United States). This case emphasizes vigilance for vascular anomalies in postpartum hemorrhage and demonstrates how advanced imaging and rapid endovascular intervention can prevent maternal morbidity and mortality.

We report a rare case of ischemic colitis secondary to amphetamine use in a 72-year-old woman, highlighting an uncommon etiology in an elderly patient. The patient, with a medical history of hypertension, deep vein thrombosis, scoliosis, and polysubstance abuse, presented to the emergency department with abdominal pain, diarrhea, and melena that had persisted for the past 24 hours. On initial examination, she was found to be tachycardic, tachypneic, and hypertensive. Diagnostic evaluation included laboratory tests, computed tomography (CT) imaging revealing severe colitis affecting the distal transverse, descending, and sigmoid colon, and a urine drug screen that was positive for amphetamines. Gastroenterology was consulted, and the diagnosis of ischemic colitis secondary to amphetamine use was confirmed. The patient was treated with supportive care and demonstrated significant clinical improvement over the next three days, with resolution of symptoms at follow-up one week later. This case emphasizes the need for healthcare providers to consider amphetamine use as a potential cause of ischemic colitis, regardless of age, and underscores the need for heightened clinical vigilance amid rising amphetamine use. Recognition of this association may broaden diagnostic considerations and guide timely, supportive management to improve outcomes in similar patients.